Face-to-face target: DME costing more than $1K

Friday, July 13, 2012

BALTIMORE – CMS issued a proposed rule last week that details its plans to require a face-to-face evaluation within 90 days of a written order for certain high-cost durable medical equipment.

The rule gives four criteria that would subject items to the requirement:

1.) items that currently require a written order prior to delivery;

2.) items that cost more than $1,000;

3.) items that we, based on our experience and recommendations from the DME MACs, believe are particularly susceptible to fraud; and

4.) items determined by CMS as vulnerable to fraud based on reports of the Office of Inspector General, Government Accountability Office or other oversight activities.

Included in the rule: a table on p. 263 that lists “specified covered items” like TENS units, rollabout chairs, manual wheelchair accessories, oxygen and respiratory equipment, hospital beds and accessories and traction equipment-cervical.

“Note that the proposed list does not include power mobility devices, which are subject to already existing face-to-face requirements, as previously discussed,” CMS stated. “In addition, we propose to add to the list any item of DME that in the future appears on the DMEPOS Fee Schedule with a price ceiling at or greater than $1,000. Items not included in one of the proposed automatic pathways would be added to the list of Specified Covered Items through notice and comment rulemaking.”

The rule will appear in the Federal Register July 30, 2012.

FMI: http://www.cms.gov/apps/media/press/release.asp?Counter=4398&intNumPerPa....