for Medicare & Medicaid Services (CMS) has delayed the enforcement of
the face-to-face physician visit requirement for certain Durable Medical
Equipment (DME), including speech-generating devices (SGDs). The announcement
indicated that full compliance and enforcement of the rule will be expected
"...beginning by a date that will be announced in Calendar Year 2014."
The rule, finalized in the 2013
Medicare Physician Fee Schedule, was originally scheduled for enforcement
beginning July 1, 2013, and then was postponed until October 1, 2013, to allow
physicians and suppliers to prepare for the new rule. This most recent delay,
issued September 9, cites "...concerns that some providers and suppliers may need
additional time to establish operational protocols...."
SGDs were on
the list of items that require a face-to-face visit with a physician or
nonphysician practitioner (NPP; i.e., nurse practitioner, physician assistant,
clinical nurse specialist). While speech-language pathologists (SLPs)
have no additional responsibilities, they should continue to work with
SGD-prescribing physicians/NPPs and inform them of the rule expected in 2014.
In the face-to-face office visit, the treating physician/NPP is expected to
review the SLP's evaluation and then write an order for the SGD and any
associated equipment recommended by the SLP.
Affordable Care Act requires a face-to-face physician office visit for certain
DME. Before submitting the written order for DME to the supplier, the
physician/NPP must document in the medical record that the visit for the
related condition has taken place within the past 6 months. The Medicare 2013
Final Rule determined the list of DME for which the face-to-face physician
office visit is required; the list was developed based on utilization and/or
cost of each DME item and includes the four high-cost SGD device codes.
Currently, the physician/NPP only needs to sign the SLP’s evaluation
for the SGD before ordering the device. The change in the rule means that (a)
the patient will have to schedule a visit with the physician/NPP before the
written order can be submitted and (b) DME suppliers must establish an
internal process that ensures they receive appropriate documentation of the
visit. When the revised rule was proposed, ASHA submitted comments opposing
the inclusion of SGDs, citing patient hardship and lack of evidence that
physicians/NPPs were issuing inappropriate orders for SGDs. CMS determined
that the cost of the SGDs justified their inclusion on the final DME list.
For updates or more information, follow ASHA
Headlines or contact a member of the ASHA’s health care economics and
advocacy team at [email protected].