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MedPAC on certain DME: Stick to in-person visits post-PHE

MedPAC on certain DME: Stick to in-person visits post-PHE

WASHINGTON – The Medicare Payment Advisory Commission (MedPAC) recommends requiring clinicians to provide a face-to-face visit before they order high-cost DME or high-cost clinical lab tests in a March 2021 report to Congress. 

The group recommends that CMS should, after the public health emergency, require clinicians to provide a face-to-face, in-person visit with a beneficiary on the date they order a high-cost DME product or lab test for that beneficiary or within six months before such date. 

“This approach – which was described in a prior commission report – would prevent clinicians from ordering expensive DME items or lab tests during a telehealth visit,” MedPAC writes. “It would help ensure that a beneficiary needs a product or test based on a needs assessment conducted by a clinician before Medicare pays for it.” 

To meet the current requirements for certain DME items, a clinician must have had an in-person or telehealth encounter with the beneficiary on the date the DME product was ordered or within six months before such date. 

“The safeguard that we are proposing differs from the current policy because our approach would require an in-person visit, while the current policy requires an in-person or telehealth visit,” MedPAC writes. “In addition, our proposal would apply to high-cost DME items and high-costs lab tests, whereas the current policy applies only to certain DME items.” 

To back its recommendation, MedPAC highlights, among others, the Department of Justice recently charging more than 300 defendants with submitting more than $6 billion in false and fraudulent claims to federal health programs and private insurers, including more than $4.5 billion related to telemedicine.   


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