Face-to-face rule will burden patients, say confused providers

Friday, June 21, 2013

YARMOUTH, Maine – A resounding 95% of respondents to a recent HME NewsPoll say CMS’s new face-to-face requirement will significantly impact patient access.

“Most likely (beneficiaries) will have to return to the doctor or practitioner, sometimes numerous times, in an attempt to obtain proper documentation,” said Shannon Turchik of Health Aid in Parma, Ohio.

The rule, which is set to take effect July 1, requires patients to have a face-to-face exam with a physician within 90 days for certain high-cost DME.

For some patients, such exams are anything but easy, respondents say.

“Many of my patients are homebound and unable to easily get out of the home, which includes doctor’s appointments,” said Amy Coulon, a physical therapist at Celtic Healthcare in Harrisburg, Pa.

On the positive side, some say the rule may offer some relief from burdensome audits.

“This will help smaller suppliers like me that can’t afford to lose in an appeal or audit,” said Lori Sears of Active Home Medical Supply in Lapeer, Mich.

Provider Paul Gammie says his company has required face-to-face exams for more than a year because the audits “got so serious.”

“Physicians hate it enough that they order less stuff, but they still order what is really needed,” said Gammie, president of Maui, Hawaii-based Gammie HomeCare.

Despite last-minute education efforts by CMS, 68% of respondents to the poll say they do not have a firm grasp on the rule. One major area of confusion: Will beneficiaries who are forced to switch providers when Round 2 starts need a new face-to-face exam?

“The new rules are as clear as mud,” said Jon Johnson, of Mercy HME in Clinton, Iowa.

Apparently, providers aren’t the only ones in the dark.

“I was at a Medicare seminar given by CMS and they didn’t even know,” said Tim Goodlett, director of operations at Omaha, Neb.-based Total Respiratory and Rehab.