WOPD requirement still problematic

Friday, January 30, 2015

WASHINGTON – CMS has been enforcing the written order prior to delivery (WOPD) requirement for a year now, but compliance is still a road filled with potholes for many HME providers, industry stakeholders say.

One big reason, says AAHomecare’s Kim Brummett: The DME MACs are requiring more than the minimum five elements outlined in the Affordable Care Act (ACA): beneficiary name, DME item ordered, prescribing practitioner’s NPI number and signature, and date of order.

“The MACs all say providers need more than that, like date stamps,” said Brummett, senior director of regulatory affairs for AAHomecare. “It’s a little over the top.”

CMS began enforcing the WOPD requirement Jan. 1, 2014. It still hasn’t started enforcing another part of the requirement, the face-to-face exam. CMS implemented both the WOPD and face-to-face back on July 1, 2013.

Compounding the problem, says industry consultant Mary Ellen Conway: Even when providers know what to get, they often have to wrestle with referral sources to get it.

“It depends on the referral source, but there are plenty of places that are trying to give you the least information possible,” said Conway, president of Capital Healthcare Group. “You have to keep bugging them.”

Additionally, there are still kinks in the system that make it difficult for providers to comply, like hospital residents who aren’t enrolled in PECOS and, therefore, don’t have NPI numbers, says industry consultant Mary Stoner.

“We’re still running into that,” said Stoner, president of Electronic Billing Services. “What is CMS going to do about that? Do they impose penalties? Do they make it advantageous in some way for the practitioner to enroll in PECOS?”

Industry consultant Andrea Stark’s issue isn’t with the DME MACs going above and beyond what’s outlined in the ACA—nine to 14 elements for WOPD are outlined in the Program Integrity Manual, she says—but with how they re-invoke the requirement after, say, a change in supplier or a change in insurance.

“What’s still problematic is that the MACs are interpreting this to be a perpetual, renewable protocol that follows the patient on an annual or semi-annual basis,” said Stark, a reimbursement consultant with MiraVista. “That’s an area that still needs to be vetted.”

Even a year in, there’s no doubt that complying with the WOPD requirement is still a lot of work for providers, Brummett says.

“I think, for the most part, providers are doing a good job going back to physicians for additional information,” she said. “Prepayment audits are so heavy, they don’t have a choice.”