Medicare Face-to-Face Rule Requirements

The Patient Protection and Affordable Care Act, through a Final Rule Released by the Centers for Medicare and Medicaid Services (CMS), now mandates that a patient’s eligibility for the DME benefit relies upon a documented face-to-face encounter between a patient and a physician.

Please see the points below as a guide to this new regulation:

General

  • The visit may be conducted by a Non-Physician Practitioner, Physician Assistant or Certified Nurse Specialist, who is under the supervision of the certifying physician, however, the office note, MUST be signed by the physician.
  • The purpose for the face-to-face encounter must be related to the reason the DME equipment is being ordered

 

Documentation:

  • The date of the encounter/last M.D. visit
  • Indication that the encounter was related to the primary reason for equipment being ordered
  • Explanation of how the clinical findings of the encounter support the need for equipment ex: oxygen, nebulizer, Bed, Hoyer lift, Wheelchair
  • Your signature, and date of that signature

 

Prescription to include:

  • PATIENT NAME, ADDRESS, DOB
  • PRESCRIPTION DATE
  • EQUIPMENT REQUESTED
  • LENGTH OF NEED
  • DIAGNOSIS AND OR ICD-9 CODE
  • MD SIGNATURE, NPI AND DATE

For a referral form, use this pdf:  REFERRAL FORM and fax to 508-998-1729

For a pdf of this information: Guide To FACE TO FACE Requirements

Please contact us if you have any questions.  We are here to help!