Medical offices rely on essential professionals like physician
assistants (PAs), nurse practitioners (NPs), and clinical nurse
specialists (CNSs) to increase practice efficiency and patient visits,
as well as support the physician with providing quality medical care.
However, Medicare’s recent proposed rule revising the conditions of
payment for prescribing Durable Medical Equipment (DME) may cut these
practice efficiencies and increase administrative burdens.
The
proposed rule will require the physician to document and communicate to
the DME supplier that he or their PA, NP, or CNS has met face-to-face
with the patient no more than 90 days before the order is written or
within 30 days after the order is written. Telehealth services are
allowed in rural areas for physicians with an approved Medicare
telehealth billing code (encounter is reported with a HCPCS code);
however, face-to-face encounters exclude incident-to services. Although a
majority of patients are seen before DME are ordered, this rule is
expected to increase the number of office visits.
During a patient visit, the practitioner will evaluate the condition
that supports the need for each DME ordered as well as conduct a needs
assessment. The physician’s documented face-to-face encounter will be
less cumbersome than that of a non-physician provider’s evaluation as it
is sufficient for a physician to provide the DME supplier with his
notes from the patient’s record regarding the patient’s history,
physical examination, diagnostic tests, summary of findings, diagnoses,
treatment plans, or other related information. If, however, a PA, NP, or
CNS conducts the patient visit, the physician must also authorize the
evaluation or attest to that meeting.
Attestation may require the
physician to sign/cosign relevant sections of the patient’s chart;
initial the patient’s history and physical examination for the date of
the face-to-face meeting; or require the physician to actually write,
sign, and date the following statement: “I, Doctor (Name) (NPI Number)
have reviewed the medical record and attest that (PA, NP, or CNS) has
performed a face-to-face encounter with (beneficiary) on (date) and
evaluated the need for (the item of DME).”
Because physicians will
spend extra time to review and authorize DME orders prepared by
non-physician providers, Medicare will pay physicians $15 under a “G
code” for that time. If a patient requires multiple DME orders and thus a
lengthier review of the evaluation, the physician will receive one
payment of $15 for the entire evaluation, provided that the physician
does not separately bill an E&M code.
The written DME order
must list: the patient’s name, item of DME ordered, NPI of the
prescribing practitioner, prescribing practitioner’s signature, date of
the order, beneficiary’s diagnosis, and necessary proper usage
instructions (i.e., duration of use, correct positioning, utilization
method) as applicable. If standard practice requires a DME order to have
additional information, that order must include these seven minimum
criteria and any additional necessary information to support a claim of
payment.
The proposed rule significantly expands the list of
covered DME items to include: (1) items that currently require a written
order prior to delivery per instructions in the Medicare Program
Integrity Manual; (2) items that cost more than $1,000; (3) items that
Medicare Audit Contractors (MACs) believe are particularly susceptible
for fraud, abuse, and waste; and (4) items that Medicare has determined
are vulnerable to fraud, abuse, and waste. Medicare estimates that
approximately 164 HCPCS DME codes are subject to the rule. Consequently,
these criteria could make any DME item susceptible to the rule because
MACs may subjectively find a DME item susceptible to fraud and abuse or
inflation could push the cost past the $1,000 threshold.
It is
also important that physicians check to see that they have properly
drafted and signed collaboration agreements with their PA, NP, or CNS.
Collaboration is a mutually agreed upon relationship between the
non-physician provider and a physician educated, trained, and/or
experienced in work related to the non-physician providers' work.
Depending on the federal and state laws, the PA, NP or CNS can
prescribe, dispense, and administer medical therapeutics or even
evaluate the patient for a DME order without the physical presence of a
supervising physician, if in collaboration with the physician. Any
prescription or evaluation submitted to Medicare or Medicaid for payment
without proper agreement, supervision, or reasonable review of a
physician may be disallowed or viewed as susceptible to fraud, abuse, or
waste.
The proposed face-to-face encounter rules will likely
increase the physicians’ time spent on administrative functions.
However, Medicare believes the potential reduction in fraud and abuse
justifies the additional expenditure of time.
Source from Physicians Practice
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