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Important Changes to the Face-to-Face Examination and Prescription Requirments

Wednesday, October 7, 2015 @ 10:10 AM  posted by jbuytaert

The Policy has been revised and Medicare in no longer making the physician sign off on the face to face notes if the f2f was performed by a physicians assistant, nurse practitioner or clinical nurse specialist. Read more below!

Face-to-Face Examination and Prescription Requirements Prior to the Delivery of Certain DME Items Specified in the Affordable Care Act – Revised

DME MAC Joint Publication

This revision incorporates changes in the prescription requirements based upon the Medicare Access and SCHIP Reauthorization Act of 2015.  The original provisions requiring that a physician co-sign a face-to-face examination that was performed by a PA, NP or CNS is removed.

As a condition for payment, Section 6407 of the Affordable Care Act (ACA) requires that a physician (MD, DO or DPM), physician assistant (PA), nurse practitioner (NP) or clinical nurse specialist (CNS) has had a face-to-face examination with a beneficiary within the six (6) months prior to the written order for certain items of DME (Refer to Table A for a list of items).

A face-to-face examination is required each time a new prescription for one of the specified items is ordered. A new prescription is required by Medicare:

  • For all claims for purchases or initial rentals
  • When there is a change in the prescription for the accessory, supply, drug, etc.
  • If a local coverage determination (LCD) requires periodic prescription renewal (i.e., policy requires a new prescription on a scheduled or periodic basis)
  • When an item is replaced
  • When there is a change in the supplier

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