As you may have heard, the Centers for Medicare and Medicaid Services (CMS) is currently deliberating the implementation of a provision of the Affordable Care Act that requires a physician to document that the physician, PA, NP or CNS has had a face-to-face encounter examination with a beneficiary in the six months prior to the written order for certain items of DME. The face-to-face encounter conducted by the physician, PA, NP, or CNS must document that the beneficiary was evaluated and/or treated for a condition that supports the item(s) of DME ordered. In the case of a DME ordered by a PA, NP, or CNS, a physician (MD or DO) must document the occurrence of a face-to-face encounter by signing/co-signing and dating the pertinent portion of the medical record. Failure to meet any of the requirements will result in denial of the claim.
The nursing community, including the WOCN Society, has been opposed to the implementation of this provision over concerns that it is unnecessary and will reduce patient access to DME products. Since 1997, both NPs and CNS' have been authorized by CMS to order DME. Ordering DME for patients is clearly an activity that is within the scope of practice of APRNs. This burden would inhibit a patient's ability to receive timely and quality care, especially in parts of the country that are already designated as a health professional shortage area.
This provision was initially supposed to be effective as of July 1, 2013; however, CMS has delayed the full implementation of the provision, as a result of the concerns expressed by the nursing community and others, until a later date sometime in 2014. This delay has caused confusion in the field as providers are being told by companies and contractors that the rule is already in effect despite the fact that an enforcement date has not yet been released by CMS.
If you are experiencing this issue we would encourage you to challenge companies and contractors by directing them to the CMS December 2013 announcement on this issue. The announcement clearly states that the provision will not be effective until "a date that will be announced in calendar year 2014."
The WOCN Society is working with the ANA and others to push for a permanent delay of this provision. In the meantime, for more information, or to write to your representativeabo ut the issue, we would encourage you to visit the ANA website.
We will continue to monitor this issue and we will keep you posted on any further developments. Please feel free to contact the WOCN Society government relations staff, Chris Rorick, at firstname.lastname@example.org if you have any questions or need additional information.
The WOCN® Society National Office