DME MACs Distribute Dear Physician Letter

The Medicare DME MACs have released a “Dear Physician” letter to educate prescribing healthcare professionals about the new face-to-face requirement for many types of “high-cost” DME.

The letter explains that “an in-person, face-to-face examination documenting the need for the item must have occurred sometime during the six months prior to the order for and delivery of” the DME.

The letter also states that the face-to-face requirement is required for prescriptions created on or after July 1, 2013.

The DME MACs began announcing the letter’s availability on Feb. 20. It’s signed by the four DME MAC medical directors.

What’s Required in Face-to-Face Documentation

The Dear Physician letter includes a list of the elements that must be included in the DME prescription, such as identification information for the Medicare beneficiary and the prescribing physician. Dosage, concentration, frequency of use and refill information are also required if applicable.

The new face-to-face examination requirement -- which is different from the existing face-to-face requirement for power mobility devices -- applies to a large range of DME, from hospital beds to oxygen, nebulizers, manual wheelchair accessories and positioning components, transport chairs, pediatric wheelchairs, ultralightweight manual wheelchairs and speech-generating devices.

At press time, the Centers for Medicare & Medicaid Services (CMS) had not yet announced the implementation date for the new face-to-face requirement. CMS has said the enforcement date would be “announced in Calendar Year 2014,” according to the cms.gov Web site.

But even though enforcement has not yet begun, industry experts have noted that once enforcement does begin, auditors could conceivably expect all claims for impacted items filed on July 1, 2013, or later to have the face-to-face exam information -- and the auditors could conceivably examine those claims accordingly.

To see the Dear Physician letter or to download a copy, click HERE

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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