CMS Proposes Face to Face Billing Requirement for DME Medicare Beneficiaries

A new rule proposed by Centers for Medicare & Medicaid Services (CMS), if passed, could require a face-to-face doctor’s meeting for any patient receiving durable medical equipment (DME) for home use. The rule was filed July 6 and was proposed by CMS in an effort to reduce fraud in the DME industry, which currently serves roughly 10 million Americans. 

Health care fraud cases, including those dealing with the Medicare system, comprised the largest return to the U.S. Treasury during fiscal year 2011, according to Nolan & Auerbach Law Firm, which deals exclusively with health care fraud. 

The rule would require that patients receiving DME schedule a face-to-face appointment with their physicians at most 90 days prior to ordering DME.

In establishing the face-to-face precedent, CMS seeks to decrease the number of fraudulent DME orders. According to the rule, they do not believe the number os legitimate orders will be affected. 

Alongside the increased face-to-face visits, CMS proposes that physicians will receive payments for costs incurred from visits which they estimate will cost $65 each. 

The projected 750,000 additional office visits are also expected to increase the quality of care for patients, and reduce the amount of error incurred when ordering DME according to the rule. 

CMS also hopes paper waste will be decreased with the passing of the rule. 

CMS will accept comments on the proposed rule for 60 days following the rule’s July 30 publication date. 

View a copy of the proposed rule here

 Written by Erin Hegarty

Erin Hegarty



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