Face-to-face rule needs new start date, say stakeholders

Friday, June 7, 2013

ALEXANDRIA, Va. – AAHomecare has asked CMS to delay the July 1 start date of its new face-to-face requirement, citing a need for clarifications and expressing concerns over the timing.

“You have this huge new requirement coming on the same day as the start of Round 2 of competitive bidding,” said Jay Witter, vice president of government affairs for AAHomecare.

In November 2012, CMS issued a final rule that requires a face-to-face exam with a physician within 90 days for certain high-cost DME.

Since then, however, the agency has done minimal—and last minute—provider education, say stakeholders, who have sought several clarifications. With millions of beneficiaries being forced to switch providers when Round 2 starts, the biggest question is whether those beneficiaries will need a new face-to-face exam, they say.

“I know how hard it is to get a quick appointment for something that is not urgent,” said Mary Ellen Conway, president of Capitol Healthcare Group. “Getting a face-to-face exam to document that the patient is on oxygen because they are now switching to a contract supplier is not going to be on any physician’s urgent list.”

Providers are not likely to take patients until they’ve had the face-to-face exam because there’s no guarantee once they provide equipment they will be paid for it, Conway said.

“CMS is going to have to figure out how those people are going to survive without it because if they pick up the phone and call on July 1, and the first day they give for an office visit is Aug. 15, they have a problem,” she said.

AAHomecare is working on a set of Q&As to help providers understand the new requirement, but it needs clarifications from CMS before it can make them available, said Witter. HME