Observation Deck

Making Sense of Face-to-Face

Providers must understand various elements for true face-to-face compliance.

The has been considerable confusion over the CMS’s face-to-face requirement, but providers need to have their face-to-face procedures in place now. The rules and requirements regarding face-to-face are complex, but must be understood.

Face-to-face encounters were added by CMS as a Medicare claims requirement for specific items of durable medical equipment beginning (as a law) July 1, 2013. The only education that has been received it the Medicare Learning Network Matters article MM8304, which was released May, 31, 2013 and revised on June 28, 2013 to provide “clarifying language” on page 2 and to provide web address for the Program Integrity Manual (PIM). The effective date was July 1, 2013 with the implementation date being set for July 1, 2013. Sound confusing?

Basically this date is the actual implementation date but, due to the issue of supplier and referral source education, the four DME MACs requested that CMS allow them to delay active auditing of the “face-to-face” part of the rule until additional education could be provided. The delay was not intended for the rule that said you must have a DWO (detailed written order) prior to delivery of the items. There was a delay that stated the face-to-face is delayed till “A” date in 2014.

This actually means that at any time in 2014 Medicare can say in 30 days it will start auditing for an implementation date of July 1, 2013. But to compound matters, CMS:

  • Delayed “active audit” of documentation till October 2013, and then delayed active auditing of the documentation until a date sometime in 2014.
  • Next, a late December an article came out that they will be “active enforcing” of the written order prior to delivery (WPD) for the face-to-face products as of Jan. 1, 2014, and this is being done specifically on hospital beds and standard manual wheelchairs.

What this Means

The actual implementation date was July 1, 2013, and that is when providers should have started following the rules and educating referral sources. Some key considerations:

  • The active auditing only refers to the four DME MAC jurisdictions and not post-pay auditors.
  • Providers need to make sure they are following the rules as they were written for July 1, 2013 implementation. Many suppliers took heed because of all the post pay audits and continued education by industry experts. The industry has updated education to suppliers pointing out specifically the need for collecting documentation up front.
    So, what do providers have to have as of July 1, 2013? Well, power mobility still follows the same rules, and many other items have specific written rules related to face-to-face documentation. Providers must have:
  • They must have a WPD — this is a written order prior to delivering the equipment and it must include specific items including the NPI of the ordering practitioner. Suppliers need to remember that some items require a length of time needed, and some may not, but include it on all orders so they do not miss one. I suggest making sure the NPI is on all orders even though it may not be required; this prevents denials.
  • The supplier can complete the WPD for the ordering practitioner to review and sign and date. Also, all signatures must be legible.

Who May Complete the Face-to-face

The are various types healthcare professionals that can complete the face-to-face requirement, but there are multiple considerations that must be taken into account for each. Let’s review:

  • An MD, PA, NP or CNS may complete the face-to-face notes and must be done within six months prior to the delivery of the item.
  • If completed by the PA/NP or CNS, then the MD must sign off that it was completed and date. If the MD signs off on a face-to-face for the PA/NP or CNS, he or she will be paid (G0454) an amount for reviewing and signing off on the face-to-face documentation.
  • The PA/NP or CNS can complete, sign and date the WPD; the MD does not have to sign off on the WPD.
  • Rural NPs are exempt from having physician sign off (this can be done by nurse practitioners who have their own NPI), but this is not yet clarified.

What Has to Be in the Face-to-Face Documentation?

There are a number of documentation requirements in order for the face-to-face to be valid:

  • The ordering practitioner must see the patient within six months prior to the delivery of the DME item for the condition for which the DME item is being ordered for.
  • Section 42 CFR 410.38(g)(3)(i)(B) specifies that documentation of a face-to-face encounter must show that the physician, a physician assistant, a nurse practitioner, or a clinical nurse specialist conducted a needs assessment, evaluated, or treated the beneficiary for a medical condition that supports the need for the specified covered item ordered. The name of the item or specific type of item does not need to be explicitly documented in the face-to-face encounter. However, the face-to-face encounter must be documented in the medical record in support of the item ordered.
  • Basically what this means is a patient can be seen by an ordering practitioner, but still must follow policy which would need to indicate that, for example, the patient might need positioning of a bed — the policy itself still has to be followed, in other words. So this is a little confusing (imagine that) and somewhat conflicts with what we need per LCD.
  • The documentation and the WPD must be received prior to delivery of the equipment.

This article originally appeared in the June 2014 issue of HME Business.

About the Author

Peggy Walker, RN, is billing & reimbursement advisor for the U.S. Rehab Division of VGM Group and can be contacted via phone at 803-754-2090.

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