• DME Face-to-Face Reference Fact Sheet

    As a result of a new CMS rule, physicians ordering certain durable medical equipment must provide documentation in the patient’s medical record a Face-to-Face encounter with the patient. This encounter must take place during the 6 months prior to the written order for the item.
    CMS requires that for Specified Covered  Items payment may only be made if a physician has provided the supplier with a written order for the item before the delivery of the item. For many items of DME, a physician must document that a physician, a physician assistant (PA), a nurse practitioner (NP), or a clinical nurse specialist (CNS) has had a face-to-face encounter with the beneficiary pursuant to that order.

    The patient’s medical record must contain sufficient documentation of the patient’s medical condition to substantiate the necessity for the type and quantity of items ordered and must be signed by the ordering physician.

    Documentation Requirements

    • Duration of patient’s condition
    • Clinical course
    • Prognosis
    • Nature and extent of functional limitations
    • Other Therapeutic interventions and results

    Key Items to Address

    • Why does the patient require the item?
    • Do the physical examination findings support the need for theitem?
    • Signs and symptoms that indicate the need for the item.
    • Diagnoses that are responsible for these signs and symptoms.
    • Other diagnoses that may relate to the need for the item.

    Documentation Tips

    • The information must not be re-corded in vague and subjective terms.
    • The information must provide objective measures, tests or observations.
    • Each medical record is expected to be individualized to the unique patient.