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Face-to-Face Encounter Requirement for Certain Durable Medical Equipment

Additional Time to Establish Protocols for Newly Required Face-to-Face Encounters for Durable Medical Equipment (DME) – December 3, 2013

On September 9, 2013, the Centers for Medicare & Medicaid Services (CMS) announced that it would begin actively enforcing and would expect full compliance with new DME face-to-face requirements on a date to be announced in Calendar Year 2014. We are publishing this announcement to make clear that the delay of enforcement only applies to the face-to-face encounter requirements and does not impact provisions related to written orders prior to delivery.

Due to continued concerns that some providers and suppliers may need additional time to establish operational protocols necessary to comply with face-to-face encounter requirements mandated by the Affordable Care Act (ACA) for certain items of DME, CMS will start actively enforcing and will expect full compliance with the DME face-to-face requirements beginning on a date that will be announced in Calendar Year 2014.

In a November 16, 2012 final rule titled “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DME Face-to-Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013” we established a face-to-face encounter requirement and new requirements for written orders prior to delivery for certain items of DME (77 Federal Register 68892).  These requirements may be found in the Code of Federal Regulations at 42 CFR § 410.38(g).

The law requires that a physician must document that a physician, nurse practitioner, physician assistant or clinical nurse specialist has had a face-to-face encounter with the patient. The encounter must occur within the 6 months before the order is written for the DME.

Although many durable medical equipment suppliers and physicians are aware of and are currently complying with this policy, CMS is concerned that some may need additional time to establish operational protocols necessary to comply with this new law.  As such, CMS expects that during the next several months, suppliers and physicians who order certain DME items will continue to collaborate and establish internal processes to ensure compliance with the face-to-face requirement.  CMS expects all durable medical equipment suppliers to have fully established such internal processes and have appropriate documentation of required encounters by a date that will be announced in Calendar Year 2014.  Those suppliers and physicians who are currently implementing the face-to-face requirement should continue to do so.

The delay of enforcement only applies to the face-to-face requirements in CFR §410.38(g)(3). CMS expects full compliance with the remaining portions of the regulation.

CMS will continue to address industry questions concerning the new requirements and will update information on our web site at www.cms.gov/medical-review. CMS and its contractors will also use other communication channels to ensure that the provider and supplier community is properly informed of this announcement.