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Posts Tagged ‘face-to-face’

DME Face-to-Face Rule Compliance Date Approaching

Wednesday, September 18th, 2013

CMS Deadline for DME Face-to-Face Certification Rules – October 1, 2013

DME Face to Face RuleThe CMS extended deadline for DME Face-to-Face encounter requirements is fast approaching. Providers need to be certain that they are in compliance before October 1, 2013.

Concerns that some providers and suppliers needed additional time to establish protocols led CMS to suspend the time when it expects full compliance with DME face-to-face encounter requirements until October 1, 2013. The compliance deadline is approaching fast and providers who are involved in DME should adopt appropriate standards and procedures before CMS commences active enforcement of the requirement.

Section 6407 of the Affordable Care Act requires a face-to-face encounter with a physician, nurse practitioner, physician assistant, or clinical nurse specialist for certain items of DME.

Most DME suppliers and physicians have implemented appropriate policies and are aware of the change in certification requirement. CMS is concerned that some may need additional time to establish operational protocols necessary to comply with this new law. Suppliers and physicians who order certain DME items should have been collaborating to establish processes to ensure compliance with the new requirement. CMS will begin reviewing for appropriate documentation of internal processes and compliance with the face-to-face requirement for DME for all patient encounters beginning on October 1, 2013.

Home Health Hospice Face-to-Face Certification Rule

Thursday, April 7th, 2011

CMS Begins Enforcing Home Health and Hospice Face To Face Rule

On March 31, 2011, the Center for Medicare and Medicaid Services issued a statement that it intends to begin enforcing the home health and hospice “face-to-face” requirement.  The Accountable care Act established a face-to-face encounter requirement before eligibility for Medicare home health services can be certified.  A certifying physician is now required to document that the physician or a non-physician practitioner that works with the physician has seen the physician “face-to-face.”  Face-to-face encounters with hospice patients must also occur  prior to the patient’s 180th-day re-certification, and each subsequent re-certification.

 The face-to-face requirement went into effect on January 1,  2011 but CMS announced in December 2010 that it would suspend enforcement for the first calendar quarter of 2011 in order to give providers additional time to establish compliance protocols.  CMS has stated that it expects providers (home health and hospices) to have fully established and implemented internal processes to be in compliance with the face-to-face requirement and by April 1, 2011, Home health providers and physicians are required to ensure that a face-to-face encounter with a home health or hospice patient occurs within the 90 days prior to the start of care, or within the 30 days after the start of care in order to appropriately certify the need for home health services.  Documentation of the face-to-face requirement must be included with patient certifications.

John H. Fisher

Health Care Counsel
Ruder Ware, L.L.S.C.
500 First Street, Suite 8000
P.O. Box 8050
Wausau, WI 54402-8050

Tel 715.845.4336
Fax 715.845.2718

Ruder Ware is a member of Meritas Law Firms Worldwide

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