Policy & Funding Home
Medicare DME Face-to-Face Rule
On July 1, 2013, a new Medicare requirement impacting physician referral sources took effect for many new orders of durable medical equipment (DME). The new Medicare regulation requires physicians or certain other practitioners to perform a face-to-face encounter, document in the beneficiary's medical record the conditions that substantiate the medical need for the DME ordered, and provide copies of that documentation to the DME provider. All of this must occur before the DME provider can bill Medicare for that claim. Since July 1, 2013, the Medicare program has made several announcements delaying the "enforcement" of this new rule. In this section you'll find the latest information on how and when CMS is enforcing this new rule.
Medicare Competitive Bidding Updates
Congress passed the Medicare Prescription Drug Improvement & Modernization Act in November 2003. In this vast legislative package were several provisions impacting our industry, including provisions providing for the phase-in of competitive bidding for durable medical equipment (DME). While the Centers for Medicare and Medicaid Services (CMS) began implementation of the national competitive bidding (NCB) program July 1, 2008, a week later Congress passed legislation and delayed implementation of NCB as part of the Medicare Improvements for Patients and Providers Act (MIPPA).
In January 2011, CMS implemented Round 1 of the bid program in nine metropolitan areas across the United States. On July 1, 2013, CMS implemented the bidding program for Round 2, which includes 91 additional metropolitan areas; these contracts end on June 30, 2016; and new contracts for these 91 areas will start July 1, 2016 and run through December 31, 2018. On January 1, 2014, CMS implemented the "recompete" of Round 1 in the same initial nine metropolitan areas, and these contracts are scheduled to expire December 31, 2016. The next round of contracts for the nine Round 1 metropolitan areas will start January 1, 2017, and will be for two years, through December 31, 2018. The section contains updates of the Medicare program's implementation of the program.
Medicare Oxygen Updates
In early 2006, Congress passed the Deficit Reduction Act. In January 2007, CMS' new Medicare payment system for oxygen equipment took effect. Find the latest information from the government to understand the impact of these policy changes on your business and your consumers.
Medicare Power Wheelchair Updates
Over the last few years, Medicare has completed a full overhaul of the power mobility device benefit. Read about the national Medicare coverage policy, HCPCS codes, fees, documentation requirements and more.
Accreditation, Anti-Fraud & More
Congress required all suppliers to be accredited as part of the Medicare Improvements for Patients and Providers Act of 2008. The deadline for all Medicare DME suppliers is October 1, 2009. This section provides all the information you need to understand the new Medicare/CMS accreditation and quality standards requirements, as well as information on other topics such as anti-fraud and more.
Reimbursement Resource Center
Find extensive information around billing and coding, reimbursement, and policies.