Face-to-face rule surprises DMEs

Tuesday, August 31, 2004

WASHINGTON - DME suppliers in July learned they too will be subject to a rule requiring face-to-face physician examinations of Medicare beneficiaries before equipment can be ordered, despite an initial belief that they would be spared from the change.

The proposal, outlined in a Medicare Notice of Proposed Rulemaking, was expected to apply only to power wheelchairs, as indicated in last year’s Medicare Modernization Act.

“We were not expecting [the rule] to apply to all items of durable medical equipment. It is pretty expansive,” said Cara Bachenheimer, Invacare’s vice president of government relations. “The legislation had said the face-to-face exams would apply to power wheelchairs, and then the Secretary [of Health and Human Services] would have the discretion to add additional items of DME.”

The proposed rule suggests several guidelines for the new face-to-face requirement for covered items of DME. Most notable is a 30-day time limit between the date of the equipment order and the beneficiary’s last physician office visit.

Some industry watchers worry this 30-day timeframe could prove troublesome for both DME providers and beneficiaries.

“Thirty days is a relatively short period of time, and we feel it is very limiting,” said Bachenheimer.

Bachenheimer said she feels the time frame should be consistent with the Certificate of Medical Necessity, which is valid for 90 days.

A second issue is that the NPRM seems to imply that in-person visits are also required for refill orders.

“That seems to be a little onerous, forcing the beneficiary to go back to their physician for an office visit, and it also does not make financial sense if there is no change in the patient’s condition and its just a refill order of the item,” said Bachenheimer. “It seems it would rack up unnecessary Medicare expenditures for physician office visits.”

Other provisions in this section of the NPRM would:

- Require the prescribing physician or practitioner to be independent from the DMEPOS supplier and not a contractor or an employee of the supplier.

- Require that the face-to-face examinations be for the sole purpose of evaluation or treating a patients’ medical conditions and not for the sole purpose of obtaining an order for DME.

- Require the prescribing physician to maintain appropriate and timely documentation in the medical records that support the need for the ordered DME.

“Overall, I don’t think anyone would object to that,” said Bachenheimer. “In the vast majority of instances, beneficiaries see their physicians during an in-office visit and that is what precipitates the ordering on an item.”

CMS will accept comments on the proposed rule, specifically on which items should be exempt from the face-to-face requirement, until September 24.