Face-to-face rule inches closer

 - 
Friday, December 20, 2013

BALTIMORE – CMS plans to start the new year by enforcing part of its face-to-face rule on Jan 1.

On Dec. 19, National Heritage Insurance Company, the Jurisdiction A DME MAC, stated in a bulletin that it would enforce the written order prior to delivery (WOPD) requirement for dates of service on or after Jan. 1.

“Providers that weren’t getting WOPDs need to start getting them,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “They are saying, ‘Do it.’”

CMS implemented the rule July 1, but the agency has delayed enforcement of the face-to-face exam requirement until some time in 2014.

How CMS will enforce the WOPD requirement but not the face-to-face requirement is a big question mark, Brummett says.

“There’s not a lot of clear direction from CMS,” she said. “We still don’t have a ‘Dear Physician’ letter, and we know there’s an FAQ that we worked on that went back to CMS months ago and we still haven’t seen it.”

CMS has stated that it delayed the enforcement of the face-to-face requirement to give providers enough time to establish protocols. Unfortunately, not everyone has done that yet, says consultant Mary Ellen Conway.

“There are always people that drag their feet in every industry,” said Conway, president of Capital Healthcare Group. “They really have to start getting set up and getting a process in place.”

Stakeholders have recommended from the get-go that providers comply with the rule as soon as possible and not wait for an enforcement date from CMS. The reason: fear that not doing so will open them up to future audits.

“We are about the only DME in our area that’s enforcing it so we have a lot of referrals who don’t understand it,” said Scott Perkins, general manager of Bradley Medical Equipment in Cleveland, Tenn. “It’s a challenge, but if the paperwork is incomplete, we can’t bill for it and we can’t just volunteer our services.”