Part B Insider (Multispecialty) Coding Alert

Published on Tue Nov 09, 2004 PDF

CMS scraps much-criticized face-to-face DMEPOS requirement... for now

Doctors who prescribe durable medical equipment have dodged a bullet.

The Centers for Medicare & Medicaid Services had planned to force docs to see patients face-to-face before prescribing any items of durable medical equipment. Experts predicted disaster for homebound patients, especially in rural areas, who would have to travel long distances just to obtain a rubber stamp for equipment their doctors knew they needed.
 
CMS Listens To Complaints

Now CMS says that due to the avalanche of negative comments the agency received, it's putting this requirement on hold for now. "This is a positive step for both physicians and the affected suppliers," says attorney Carol Loepere with Reed Smith in Washington, DC. The original rule was "too broadly drawn" and would have cut off access to equipment that patients really needed, she added.

"[The rule] would be extraordinarily difficult to enforce," adds Minneapolis, MN physician Edward Ratner, a former president of the American Academy of Home Care Physicians. "It would be an appropriate rule for selected DME," such as high-fraud items, but not for all DME, he says.

"An unnecessary visit to the physician just to get the equipment may add more costs than the price of the DME," Ratner adds. If Medicare wants physicians to take a more active role in overseeing DME, the program should pay doctors a fee for this service, similar to the care plan oversight it pays for with home nursing.

Ratner also points out that next year's drug benefit will include coverage for home infusion medications, most of which Medicare doesn't currently cover. If Medicare wants physicians to oversee DME in the home, policy-makers should wait until next year and then include home infusion in the solution.
 
Seeing Patients First Is Still A Good Idea

Even without the requirement, doctors should see the patient most of the time before prescribing DME, says coder Mary Brown with OrthoWest in Omaha, NE. The only times when Brown sees a need for a patient to receive DME without seeing the doctor would involve a replacement for a previously ordered item. But there's no modifier or other device to tell CMS when a patient is receiving a replacement item as opposed to a new item, she notes.