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Compliance: Check and check again

Compliance: Check and check again Q. How are providers dealing with the face-to-face requirement?

A. The Affordable Care Act requires the treating practitioner to conduct an in-person or “face-to-face” office visit with the patient prior to prescribing certain DME items, including CPAPs, hospital beds, manual wheelchairs, etc. The practitioner must document the face-to-face encounter, detailing the need for each prescribed item. Providers are required to obtain compliant documentation prior to delivery.

ACA contained surprises beyond the additional face-to-face requirement. Never before has CMS written language requiring a provider to pick up their equipment and a new supplier re-deliver if the notes do not adequately document medical necessity. If an error is found in the face-to-face notes or the written order prior to delivery, the supplier may request corrections or an amendment be made according to the guidance in the Program Integrity Manual. If the error is discovered after the DME item is delivered and the provider has not yet billed the claim, the provider must pick up the equipment, have the corrections or amendments made to meet the coverage criteria, then re-deliver the DME item. However, if the claim has been billed and the error is discovered after billing, the provider must pick up the DME item and a new supplier must deliver the equipment.

It is paramount that you check, check again and triple-check both the written order and the face-to-face notes thoroughly to make sure they are compliant with the coverage criteria before delivering the equipment. One operational protocol that many DME suppliers have instituted is having their sales team introduce doctors and practitioners to online algorithmic templates to use during DME face-to-face exams to ensure that paperwork is compliant.

Jamie Loper, ATP, chief compliance officer,, can be reached at [email protected] or 800-986-9368.


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