November 13, 2012

New DME Requirement in Physician Fee Schedule

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Durable medical equipment (DME) suppliers will have to ensure their patients have had face-to-face visits with the physicians who order certain equipment if they want Medicare to pay for it.

Starting July 1, the new requirement, which is in the final 2013 Medicare physician fee schedule, is an effort to reduce waste, fraud and abuse, the rule stated.

The patient’s face-to-face visit with a physician or non-physician practitioner must occur within the six months before a written order for items such as hospital beds, portable oxygen systems and manual wheelchair accessories, the rule stated.

The rule also contains information about required physician documentation of the face-to-face encounter. When the physician conducts the visit, she must submit pertinent portions of the medical record that show evaluation, needs assessment and treatment of the beneficiary for the medical condition that supports the need for DME, the rule stated. When a non-physician practitioner completes the face-to-face visit, the physician must sign the portion of the medical record indicating a face-to-face encounter occurred.

For more information, look up the final 2013 Medicare physician fee schedule in the Federal Register.

Fraud News

  • Staff physician at Detroit-area clinics sentenced to five years in prison. Jonathan Agbebiyi, an obstetrician/gynecologist, was convicted in connection with a $5.4 million scheme involving billing medically unnecessary neurological tests – including some that sent electrical currents through the arms and legs of patients, according to the U.S. Attorney’s Office in eastern Michigan. He also will pay almost $3 million in restitution.
  • Former Jasper County, Mo., administrator pleads guilty in Medicaid scheme. Rita Frances Hunter directed employees to submit false applications for Medicaid funds totaling $70,000 to $120,000, according to the U.S. Attorney in western Missouri. She faces up to five years in prison and a fine of up to $250,000.
  • Missouri hospital discloses improper compensation for physicians and will pay $9.3 million. Freeman Health System paid incentives to 70 physicians based on revenue generated by their referrals for diagnostic testing and other clinic services, according to the Justice Department. “This financial arrangement created an incentive to refer patients for such procedures,” the Justice Department states in a press release.

RAC News

Recovery auditors (RACs) did not post new issues this week.

About the Author

Karen Long is the editor of Physician Solutions for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals. In her almost four years at DecisionHealth, Karen also has been the compliance editor and a reporter for Home Health Line, nation's leading independent authority on home healthcare business, regulation and reimbursement.

Contact the Author

KLong@decisionhealth.com

To comment on this article please go to editor@racmonitor.com

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Karen Long

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