Ask-the-Contractor Teleconferences (ACT)
Provider Outreach & Education
Date: May 25, 2016
Operator: Good day and welcome to the CGS Jurisdiction C
ACA 6407 Revisions Ask the Contractor Teleconference call.
Today’s conference is being recorded. At this time I would
like to turn the conference over to Michael Hanna. Please
go ahead sir.
Michael Hanna: Thank you (Rochelle). Good afternoon
everyone. We would also like to welcome you to the CGS
Administrator’s DME MAC Jurisdiction C Revisions to
the Affordable Care Act Section 6407 Ask the Contractor
Teleconference. For the remainder of this teleconference
we will refer to the Affordable Care Act Section 6407 as
simply “ACA 6407.” Moving forward, Ask the Contractor
Teleconference will be referred to as “ACT call.”
Before we make reference to ACA 6407 requirements
technically these Social Security Act Section 1834(a)(11)(B)
and its implementing regulation at 42 CFR 410.38. There is
no need to write all this information down as it will be in the
transcript that we upload to our website within a few weeks
after the call completes.
It’s important to note that the CMS regulation contains
the details for the face to face examination, written orders
prior to delivery, and the list of items subject to these
requirements. These ACT calls are hosted by the DME
Provider Outreach and Education Team who are joined by
Jurisdiction C subject matter experts. For this particular ACT
call you may ask questions concerning or related to the
April 28, 2016 article titled “Face to Face Examination and
Prescription Requirements Prior to the Delivery of Certain
DME Items Specified in the Affordable Care Act.”
Before we begin taking your questions I want to provide a
brief summary of those revisions as well as a few details
on where you can locate some helpful documents on our
website. In addition to the document referenced just a
moment ago, a “Frequently Asked Questions document and
a revised “Dear Physician” letter concerning ACA 6407 were
uploaded to our website, http://www.cgsmedicare.com on
April 28, 2016. To access all of these publications go to our
website and click on the DME MAC Jurisdiction C tab at
the top of the page. Click “News and Publications” from the
navigational words and phrases on the left-hand column then
click “News.” Simply scroll down the page until you see these
items. They are close to the top of the April 2016 entries.
I want to turn our attention to the discussion of two major
revisions and the language surrounding ACA 6407. First, the
suppliers are not required to have the face to face encounter
medical record in their possession prior to delivery of the
DME item. That medical record, however, must be made
available upon request by any auditing entity. The face to
Page 1
Originated June 7, 2016.
© 2016 Copyright, CGS Administrators, LLC.
Moderator: Michael Hanna
Time: 1:00 p.m. CT
face visit with the beneficiary must be within six months
before the orders were written and before delivery of the
equipment. There must be notations of an evaluation and/or
treatment of a condition that warrants the item in question.
And as a reminder, all LCD and standard documentation
requirements still apply. There are no changes there.
Second, for items subject to ACA 6407 the supplier can
provide the equipment based on a five element order. The
five elements for this particular type of order are:
• Beneficiary’s name,
• Description of the item (the description can be general or
more specific) For example, “hospital bed” will suffice for
a five element order as well as “semi-electric hospital
bed with side rails” – either one are perfectly acceptable.
• Physician signature,
• Date of the order,
• Physician’s NPI.
The five element order must be written within six months of
the face to face encounter requirement we just reviewed.
The five element order must be received by the DME
supplier prior to delivery of equipment to the Medicare
beneficiary. This five element order must have a date stamp
or equivalent to indicate receipt by the supplier prior to
delivery of the equipment.
The supplier is no longer required to have a valid detailed
written order prior to delivery of these items. They must,
however, get a signed and dated valid detailed written
order that meets all requirements in the LCD and standard
language documentation requirements before billing the
Medicare program for the item.
Just to quickly review . . . you do not have to have the
face to face encounter in your records prior to delivery. If
requested by an auditing entity you must have a record
of that encounter and provide it to the auditing entity in
question. You no longer have to have a signed and dated
valid detailed written order from the physician prior to
delivery. However, you must have an order that includes
at least the five elements in question that I went through
moments ago.
The most efficient way to keep up with changes in current
topics at CGS and the Medicare program overall is the
CGS DME ListServ. We typically send one email every
afternoon with pertinent information for our supplier
community. ListServs typically include information concerning
CMS upcoming calls, new Medicare Learning Network
publications, coding revisions, our CGS Medical Review
quarterly report status updates, and webinar or workshop
registration notifications. If you are not signed up or you have
Ask-the-Contractor Teleconferences (ACT)
Ask the Contractor Teleconferences (ACT)
staff that would benefit from our ListServ, go to the Jurisdiction
C homepage on our website and scroll to the very bottom of the
page. Click on “Join/Update ListServ” under Utilities. It only takes
a few seconds to sign up and there is no limit to the number of
employees that can receive our ListServ announcements.
Before we open the phone lines for questions please be aware
that we are not able to answer questions about individual
claims. Do not provide beneficiary names or Medicare numbers
in your question as we want to assure confidentiality and
protect our member’s health information. If you have a question
regarding a specific claim or beneficiary our Provider Contact
Center representatives are available for you from 7:00 am to
5:00 pm Central, Monday through Friday at (866) 270-4909.
As I stated earlier, a transcript of today’s call will be added to
our website. When that transcript becomes available it will be
uploaded to our ACT call webpage. We will alert you via a ListServ
announcement once that upload takes place. We are now ready to
begin the Q&A portion of the call. I will now turn the call back over
to our teleconference specialist (Rochelle) who is going to prepare
the lines and queue your questions. (Rochelle) . . .
Operator: Thank you. The question and answer session
will be conducted electronically. If you would like to ask a
question please press star followed by the digit 1. If you are
on a speakerphone please make sure your mute function is
turned off to allow your signal to reach our equipment. A voice
prompt on your phone will indicate when your line has been
opened. Once again star 1 to ask a question and we’ll pause
for a moment to assemble the queue. And we’ll take our first
question. Caller please go ahead.
Female: Hi. Yes you said if there’s no – you talked about order
product delivery required we just need a detailed written order
prior to billing. My question now revolves around the date stamp
that we have to have it date stamped proving that we received it
prior to delivery and the transition of those if we don’t have that.
Is that no longer in play either?
Michael Hanna: No. I stated that you must have a five element
order. And that must be date stamped prior to delivery of those
items. So . . .
Female: So if we don’t have that we still have to transition those
to another provider?
Michael Hanna: Correct – the joint DME MAC article
concerning corrections and amendments dated August 28,
2014, still applies.
Female: Okay.
Michael Hanna: If you notice an error in either the face to face
documentation or the order prior to delivery simple reach back
out to the physician and get corrected information. Or, if you
notice the error prior to billing you can simply receive your
equipment back, get corrected information and then redeliver
the equipment.
Page 2
May 25, 2016
Female: Okay. So you’re just not calling it a detailed written
order prior to delivery anymore; we’re now going to transition
back over to a five element order?
Michael Hanna: It’s a five element order. However, for billing
you still must have a valid detailed written order that follows
guidelines in the appropriate LCD and/or Chapter 3 of the DME
MAC Jurisdiction C Supplier Manual.
Female: Perfect, thank you so much.
Michael Hanna: Thank you.
Operator: And we’ll move on to our next question. Caller please
go ahead.
Female: Hi. So what is the difference between a five element
order and a detailed written order for CPAP?
Michael Hanna: Well, the five element order is now what’s
required prior to delivery for any item including the CPAP – the
E0601 – that’s listed as part of the Affordable Care Act Section
6407. If you recall, I said there must be a description of the item
that can be general or specific. That’s one of the nuances. A
detailed written order does not require a physician’s NPI. So
that’s another difference. All the elements for a detailed written
order are listed in the LCD for PAPs.
Female: Okay. So we need a five element order prior to delivery
and a detailed written order prior to billing?
Michael Hanna: Correct.
Female: Okay, but if we have all of it prior to delivery then that’s
just good. Okay.
Michael Hanna: Yes. If you have an order that meets all
requirements for the five element order as well as every
element for a valid detailed written order then simply date
stamp it and then you can deliver the equipment.
Female: Okay. Then let me get clarification on the start date
because this is where we’re getting hung up. And it’s my
understanding that say we receive an order on the first and we
set that person up on the third, okay? We’re good without the
doctor writing in the third the date specifically because it’s we’re okay, right? You don’t have to have a specific set up date
that comes after the order of start date rather?
Michael Hanna: I think you’re referring to the order date as one
of the elements of a valid detailed written order. The term “start
date” was removed from all standard language a couple months
ago this past spring.
Female: Okay.
Michael Hanna: As I answer, I’m going to answer from the
CGS DME Medical Review standpoint. This is an overall
response, not necessarily ACA 6407 only, but for any item
Originated June 8, 2016
© 2016 Copyright, CGS Administrators, LLC.
Ask-the-Contractor Teleconferences (ACT)
Ask the Contractor Teleconferences (ACT)
that’s DMEPOS because every piece of equipment and ever
supply item or accessory requires an order before you can
build a program correct?
Female: I had a question as far as the effective date of those
revisions. I needed to know how far back I can go to fight with
redeterminations or reconsiderations on some of my claims.
Female: Correct.
Michael Hanna: This was published on all of the DME MAC
websites on April 28, 2016. For anything that’s already in the
appeals process, you would need to continue to follow the
appeals process as such. If it’s not been reviewed, you can
refer to that date because it’s April 28, 2016, moving forward.
Michael Hanna: Okay. One of those elements is an order date
and another element is the physician signature date. If CGS
Medical Review stops a claim on the front end during initial
processing, you get an ADR letter. If the CGS DME clinician can
easily tell the order came from the physician they will find the
order acceptable if one date is on the document.
Female: So any deliveries April 28, 2016, we would need a five
element order not a WOPD like it was before?
Female: Okay.
Michael Hanna: Correct.
Michael Hanna: Maybe this is a physician’s prescription pad
or a template that has “Dr. John Jones Family Practice” or
something like that at the top.
Female: Okay. Okay, that was my question.
Female: Okay.
Female: Thank you.
Michael Hanna: Now if the order has “ABC Medical Supply” or
simply “Detailed Written Order,” or “DME Order,” or something
that is either supplier specific or very generic in nature then we’re
going to be looking for two dates – the date of the order, which is
going to be the date that you received either the dispensing order
or the five element order depending on if it’s an ACA item or not,
as well as the physician’s signature date. You can complete the
detailed written order in its entirety except for the physician’s
signature and the signature date. The physician is reviewing
the detailed written order and their signature and date of that
signature basically lets us know that they agree with everything
on that order and you’re ready to move forward.
Operator: And we’ll move on to our next question.
Female: Okay. So okay so good. So then we have the order
date, the physicians date and like you said you eliminated the
start date then?
Michael Hanna: Yes. You will notice the language is removed in
the last update to the Supplier Manual, Chapter 3 as well as the
LCD revisions that took place in the spring of 2016.
Michael Hanna: Thank you.
Female: Hello. Thank you for taking our question. Today we
needed clarification on the statement made at the beginning
of this call. I believe the statement was that for face to face
documentation we, the DME supplier, did not need that prior
to delivery but we needed to make it available for any auditing
bodies. Is that correct?
Michael Hanna: That is correct.
Female: Okay. So what we’re finding now from auditing bodies
is that they are denying because we don’t have a received a
date and time stamp prior to delivery of the device on those
face to face documents?
Michael Hanna: Was that documentation submitted prior to
April 28, 2016?
Female: Some of them yes.
Female: Okay.
Michael Hanna: Okay.
Michael Hanna: The order date is there but the “start date”
terminology has been removed.
Female: That was the start date of change.
Female: Excellent. That’s what I had. Thank you very much.
Michael Hanna: Thank you ma’am. I appreciate you letting me
explain that to you.
Page 3
May 25, 2016
Michael Hanna: Keep in mind, this information was not
published on any of the DME MAC websites until April 28, 2016.
Female: Okay. So effective April 28 then same as that start date
that was discussed before, we should not have this issue going
forward with the auditing bodies?
Operator: And we’ll move on to our next question. Caller please
go ahead.
Michael Hanna: Correct.
Female: Hi Michael.
Female: Okay, thank you. That’s great information.
Michael Hanna: Good afternoon.
Michael Hanna: I appreciate it, ma’am. Thank you.
Originated June 8, 2016
© 2016 Copyright, CGS Administrators, LLC.
Ask-the-Contractor Teleconferences (ACT)
Ask the Contractor Teleconferences (ACT)
May 25, 2016
Operator: And we’ll move on to our next question. Caller please
go ahead.
I’m not giving you another order. I’ve provided you an order.
Leave me alone. I have enough paperwork to deal with.
(Morna): Good afternoon. My name is (Morna). And I have one
question. Chapter 3 of the Supplier Manual continues to include
for the Affordable Care Act items a WOPD that does require that
the prescribing practitioners NPI be part of the order. The plain
WOPD five element order would be okay for the supplies but is
this change on the Affordable Care Act going to eliminate the
need for NPI on that initial order?
And so you’re putting us really between a rock and a hard
place without telling the doctors in the same letter that the rules
for billing have not changed and to get paid for it the supplier
is going to need a detailed written order. It implies this letter
implies that this is all that’s needed for their – from them for their
patients to get this equipment.
Michael Hanna: No. If you recall when I talked about five
element order the physician’s NPI was one of those elements.
For example, since for PAP claims, the E0601 or the E0470,
both HCPCS codes are listed in Section 6407 of the Affordable
Care Act, the five element order must include the NPI.
Michael Hanna: That letter outlines the revision for ACA items.
A detailed written order has not changed.
Male: And you don’t think that a doctor getting this letter thinks
that the rules have been changed that this doesn’t clearly tell
them that this is all they need to provide to us?
(Morna): Thank you.
Michael Hanna: It’s not my opinion that matters.
Michael Hanna: The detailed written order does not have to
include the physician’s NPI but the five element order does. Using
my example for the PAP or RAD device only, it is not necessary
for the supplies because they are not part of ACA 6407.
Male: Okay.
(Morna): So we continue to wait for orders that do include an
NPI prior to issue of equipment?
Michael Hanna: That letter was provided to the supplier community
to forward on to physicians where they think there might be an
issue or the physicians don’t understand the revisions. We also
have a number of other “Dear Physician” letters available on our
website under the Medical Review section.
Michael Hanna: You need a five element order now before you
can dispense the equipment to the beneficiary.
Male: So this letter was not – has not has not been provided by
CMS to doctors?
(Morna): Thank you.
Michael Hanna: No. The “Dear Physician” letter is posted on the
DME MAC websites.
Michael Hanna: Yes.
Male: Okay. Well that’s good – that’s good to know.
Operator: And we’ll move on to our next question. Caller please
go ahead.
Male: Thank you. You know, we’ve spent several years training
doctors that valid orders require a detailed description of the
item order and a signature date. And this letter revised April
28 now tells them that they don’t need those elements. Now
of course they do need them or we need them to get paid but
there’s nothing in this letter that explains that to the doctors.
So when we try to tell them send them an order or give us a
detailed order or we don’t get paid they say no, no I’ve got a
letter from Medicare saying this is all you need. How do you
respond to that?
Michael Hanna: That revised letter talks about the five element
order. For billing purposes we still must have a detailed written
order that’s outlined in the LCD or Chapter 3 of Supplier Manual.
Male: And suppliers like me realize that but when a doctor reads
this there’s nothing all this says is doctors this is what you need
for your patients to get this equipment. It doesn’t say oh by the
way the supplier will need a different order in order to get paid.
And so what happens is we have doctors when we go back to
them and say now I need a detailed written order they say no
Page 4
Michael Hanna: It’s for you – the supplier community – to help
when you have physicians that may not really understand how
the DME side of Medicare works. You can provide this letter
authored by the DME MAC Medical Directors to help them with
understanding.
Male: Can we as suppliers basically continue to have a policy
of only delivering this ACA this equipment that come -falls within
this statute when we get a full detailed written order because
we have a hard time getting the detailed written order if we’ve
already provided the equipment?
Michael Hanna: Yes. That’s acceptable.
Male: Okay.
Michael Hanna: The only nuance, if you will, for orders and ACA
6407 from April 28 was that you can provide equipment based
on an order that contains the five elements.
Male: Right.
Michael Hanna: If working with your referral sources these past
couple years you’ve got them pretty well understanding the fact
Originated June 8, 2016
© 2016 Copyright, CGS Administrators, LLC.
Ask-the-Contractor Teleconferences (ACT)
Ask the Contractor Teleconferences (ACT)
that they’re going to have to have a valid detailed written order up
front that’s acceptable as long as you’ve got the date stamp . . .
Male: Yes.
Michael Hanna: . . . and as long as that detailed written order
has got the physician NPI on it you’re probably good.
Male: Okay, perfect. Thank you.
Michael Hanna: You bet.
Operator: And we’ll move on to our next caller. Please
go ahead.
Female: Yes I have – I’m trying to figure out the difference and
now the revision to the Affordable Care Act and the LCD. So
now we pretty much don’t need anything prior to dispensing
besides the five elements?
Michael Hanna: That’s all that’s required, yes.
Female: You don’t have to have the face to face notes or
anything in hand prior to dispensing?
Michael Hanna: It might depend on the LCD. When I read
this information or discussed this information with everyone
this was an overall for ACA 6407 requirement. There are
some LCDs that are more strict. For example, the oxygen and
PAP policies both require a face to face examination prior to
dispensing the equipment.
Please don’t confuse these changes or revisions in the ACA
6407 with requirements for the LCD. The DME MACs have
never audited for face to face as part of the Affordable Care Act
however we have audited where the LCD requires some type of
face to face visit that is part of getting the equipment or getting
the DMEPOS item.
May 25, 2016
Female: Hi. I need to get some clarification on the five element
order. They have to have the name of the item, physician
signature, date of the order and the NPI that kind of like
replaces a dispensing order at this time and then you still get
your detail written order after that if the LCD says it’s required
before delivery is that correct?
Michael Hanna: Yes, for the most part. I suppose I would say
that the five element order is similar to the dispensing order;
however, a dispensing order does not require the NPI. The five
element order is only for items part of ACA 6407. Now if the
LCD requires a valid detailed written order prior to delivery such
as a support surface, or power mobility device, or wheelchair
seat cushion or back cushion; you still must follow LCD
guidelines. For an item that is not part of ACA 6407, such as a
folding wheeled walker or a commode chair, then yes you can
provide that based on a dispensing order and then follow-up
with the detailed written order.
Female: So I can go to the medical review or the manual online
and go through the ACA 6407 and it will tell me what items fall
under that?
Michael Hanna: Yes, I would actually go to that article on April
28, 2016. There’s a table at the end of the article that details the
HCPCS and item descriptions.
Female: Okay.
Operator: Next caller please go ahead.
Female: Hello I’m sorry I’m asking another question because I
joined the call late. For things like CPAP do I have to have the
face to face dictated and stamped and in my possession prior
to delivery?
Michael Hanna: No.
Female: No.
Female: Right. We’ve – because we’ve been denied recently
for no date stamp showing you had your face to face notes prior
to dispensing.
Michael Hanna: Was that prior to April 28, 2016?
Female: No sir, it was after.
Michael Hanna: Then I would contact the Provider Contact
Center or file an appeal.
Female: So face to face notes – the only thing that requires a
date stamp is your five element?
Michael Hanna: That requirement has been removed based on
the April 28, 2016, article.
Female: So if I have – if I know he’s had a face to face and a
sleep study and I have a five element order I can put a CPAP
out as long as I obtain all of that stuff prior to billing it?
Michael Hanna: Correct. If you feel the requirements have
been met – since you used PAP as an example – I would make
sure that the face to face took place before the sleep study.
And regarding the sleep study – the sleep test interpretation
indicates how they’ve met the AHI/RDI requirements for
Medicare coverage.
Michael Hanna: Correct.
Female: Thank you.
Operator: And as a reminder it’s star 1 to ask your question.
We’ll move on to our next caller. Please go ahead.
Page 5
I can’t reiterate this enough for everyone on the call: LCD
requirements are not changing with this revision. If an LCD
requires something that is more strict or more stringent than
ACA 6407 you should follow the LCD. The DME MACs have
never audited for the face to face encounter prior to delivery
Originated June 8, 2016
© 2016 Copyright, CGS Administrators, LLC.
Ask-the-Contractor Teleconferences (ACT)
Ask the Contractor Teleconferences (ACT)
as part of the ACA, however, we have audited when the LCD
requires a face to face encounter, or a certain test or something
else prior to delivery.
Female: Okay. So you’re saying that the LCD could still be
requiring that I have possession of a face to face prior to
delivery?
Michael Hanna: You don’t have to have possession of the medical
records but if you provide the equipment and you’re asked for it
by an auditing entity, you need to get that documentation.
Female: And if I – if here’s what happens okay? I get my studies.
I get my order. I have the RDI. I have everything but for whatever
reason the face to face dictation is a low priority at the institution
and so it lags behind. So I know it was done I just don’t have
possession of it? And we’ve been waiting to set people up until
after we had possession of it which delays treatment.
May 25, 2016
Male: Oh you mean in the manual on the Internet only, okay.
Michael Hanna: Yes the CMS Internet Only Manual –
specifically the Program Integrity Manual, 100-8, but please
don’t quote me on that.
NOTE: Added after the teleconference: CGS published a News
article on July 17, 2014, outlining amendments to electronic
health records. Suppliers are free to utilize this resource, too.
The IOM reference indicated above – it is the CMS Internet Only
Manual, 100-8, the Program Integrity Manual.
Male: Yes.
Michael Hanna: I can make sure that I check before we do
the final transcript and add a note to the effect so when it’s
published it will have the actual IOM reference.
Male: Thank you. That would be helpful.
Michael Hanna: The revision from April 28, 2016, should take
care of that issue because the article states the supplier no
longer has to have that face to face encounter in possession
with a date stamp prior to delivery.
Operator: And we’ll move on to our next question. Caller please
go ahead.
Female: Okay. But I do have to have it before I bill in case
they audit?
Female: Yes. My question is on the five element order versus
your detailed order. If for some reason you have your detailed
order in and it’s complete in its entirety can the detailed order
ever take the place of the five element order.
Michael Hanna: You must provide that documentation if it’s
requested by an auditing entity.
Michael Hanna: If you have a valid detail written order up front
that includes . . .
Female: Okay. All right thank you.
Female: All of the elements.
Michael Hanna: Yes ma’am.
Michael Hanna: . . . all of the five elements . . .
Operator: And we’ll move on to our next question. Caller please
go ahead.
Female: Yes.
Male: Yes when we’re dispensing like an LSO and we ask for
the medical records and we find that doctors are leaving out
simple things like rigid or semi rigid. Before we dispense is the
doctor able to fix the medical record or it’s too late the patients
not in front of him anymore we’re having that’s where we’re
having problems simple words are missing.
Michael Hanna: It also includes a detailed description of the
item being provided such as “semi-electric hospital bed was
side rails” versus “bed” then yes, that’s perfectly acceptable.
Make sure you date stamp that to show that you have it prior
to delivering the equipment and then deliver the equipment to
the beneficiary.
Michael Hanna: LSOs are not part of the Affordable Care Act so
your question is not really valid for this phone call but I’ll answer
it anyway. Essentially your question is this – can the physician
amend their medical record? Is that what you’re asking?
Female: Okay. So that is acceptable then?
Male: Yes.
Michael Hanna: Yes they can, amendments and corrections
are accepted. The guidelines are authorized in the Internet
Only Manual.
Michael Hanna: Yes. You can only provide the equipment
based on the five element order. If you have the valid detailed
written order up front that includes all those elements namely
the physician’s NPI, then yes, please move forward. If you’ve
been using that as a business model or accepted as part of the
practice and your referral sources are used to you requesting
information and readily provide it, that’s fine.
Female: Okay, thank you.
Male: In the Internet Only Manual?
Operator: Next caller please go ahead.
Michael Hanna: Yes.
Michael Hanna: Your line is open.
Page 6
Originated June 8, 2016
© 2016 Copyright, CGS Administrators, LLC.
Ask-the-Contractor Teleconferences (ACT)
Ask the Contractor Teleconferences (ACT)
Operator: Please go ahead caller, your line is open. And not
hearing your response we will move on to our next question.
Caller please go ahead.
Female: Hi Michael. I want to ask a question just simply tell me
what you all need us to date stamp?
Michael Hanna: Well the easiest thing to do is go to some type
of office supply store and buy a date stamp and ink pad.
Female: Right. Yes I know but what element – now I understand
that all I need to stamp is the valid detail written order before you
bill or the five element order or detail order before you deliver?
Michael Hanna: For ACA 6407 items you must have a five
element order . . .
Female: Right.
May 25, 2016
Caller please go ahead.
Female: Hi. I actually have two questions. Can the certificate
of medical necessity be used as a written order for instance
oxygen?
Michael Hanna: If it’s in a real CMN such as the one required by
CMS oxygen then that’s perfectly acceptable, yes. A CMN – if it’s
completed in its entirety and Section C is sufficiently completed
– it can be considered a detailed written order.
Female: Okay. And then just a clarification on the five element
order compared to the detailed written order so if we receive the
five element order and it’s dated say May 9 and we deliver the
items May 10 and the detailed written order is dated after that is
that acceptable?
Michael Hanna: What do you mean dated after that? Signed
after that?
Michael Hanna: . . . and that must be date stamped by you to
show that you had possession before you deliver the equipment.
Female: Correct.
Female: Unless you have the valid detail written order before.
Michael Hanna: By the physician?
Michael Hanna: That’s correct.
Female: Correct.
Female: If that be the case you date stamp that?
Michael Hanna: Yes. So in your example you received the five
element order May 9 and you deliver the equipment May 10.
Michael Hanna: Correct.
Female: Yes.
Female: Okay. No face to face has to be date stamped
anymore?
Michael Hanna: The revisions state that you do not have to have
that face to face encounter in your possession prior to delivery.
Michael Hanna: Here is an example – You put in your system
the order date as May 9, you complete the template in your
system, it spits out a completed detailed written order, you send
that to the physician and they sign it on the 12th.
Female: Yes.
Female: Correct.
Michael Hanna: If requested by an auditing entity, though, you
must be able to provide that medical documentation.
Michael Hanna: Once you get that signed and dated order back
from physician then you can bill the Medicare program for that
May 10 date of service.
Female: Okay. But that’s not even in the LCD oxygen and
((inaudible)) where you have to date stamp face to face?
Michael Hanna: That’s correct.
Page 7
Female: So how does that effect if it was our delivery date is
different than the billing date? So for instance we delivered the
items on May 10.
Female: So there’s no date stamp even in the – so the date
stamp has been eliminated kind of except for that one thing that
they know you got that detailed order in your hand before you
carry your merchandise or your equipment?
Michael Hanna: It won’t be. You’re still billing May 10. You just
can’t bill until you get the detail written order.
Michael Hanna: That’s correct.
Michael Hanna: Correct. You did not have the signed completed
detailed written order in your possession until May 12.
Female: As far as submit the claim?
Female: Okay, All right good deal. I’m getting some keys.
Thanks Michael.
Female: Oh perfect, that really helps. Thank you so much.
Michael Hanna: Yes ma’am. Have a good afternoon.
Michael Hanna: Yes ma’am.
Operator: And we’ll move on to our next question.
Operator: And we’ll move on to our next question.
Originated June 8, 2016
© 2016 Copyright, CGS Administrators, LLC.
Ask-the-Contractor Teleconferences (ACT)
Ask the Contractor Teleconferences (ACT)
May 25, 2016
Caller please go ahead.
Michael Hanna: And you have orders . . .
Operator: Please go ahead.
Female: Hello. I have a couple of questions. The 6407 is there
an effective date or an anticipated date for the E0784?
Female: Because the new physician is the patient’s Medicare
doctor or the physician that he sees now that he has Medicare
primary. His old insurance company was ABC so he was seeing
a different physician.
Michael Hanna: Is the E0784 part of the Affordable Care Act?
Michael Hanna: Okay.
Female: Yes.
Female: That’s our – that’s the challenge we’re going to run into
is we’re going to have a face to face from a physician with one
NPI and an order from a physician with a separate NPI. Is that
going to be an issue?
Michael Hanna: Then April 28, 2016. That revision is valid for all
HCPCS codes that are part of ACA 6047.
Michael Hanna: Yes ma’am.
Michael Hanna: No. Early on in ACA discussions, CMS clarified
that the physician or practitioner who conducts the face to face
does not have to be the same one that writes the order.
Female: Okay.
Female: Okay, thank you.
Michael Hanna: The clarifying article, a set of FAQ questions,
and the revised “Dear Physician” letter were all published April
28 under the News section of our website.
Michael Hanna: Yes ma’am. I’m sorry I didn’t understand for a
moment. I apologize.
Female: And that was April 28 you indicated?
Female: You are fine, appreciate it.
Female: Okay. Next question I have we have a physician that
has been working with Medicare patients for a long time and they
know they are not required to provide documentation such as face
to face unless the DME MAC or an auditing entity requests it.
Operator: And we’ll move on to our next question. Caller please
go ahead. Please go ahead. Your line is open. And not hearing a
response we will move on to our next caller. Please go ahead.
So we as a provider cannot make them give us a face to face
unless we are audited. If we have a patient that has recently
become Medicare primary and now has a new physician how
are we to gauge if there would have been a face to face six
months prior so there’s no interruption in the continuum of
care for our patients?
Female: Hi yes. I had a question regarding the detail part of
the order. So when it says item of DME ordered and it says
“hospital bed.” That can be generic and no longer has to say
“semi-electric” but what about wheelchairs? So if a patient – if
the doctor just writes “wheelchair” can we then dispense either a
standard or a lightweight?
Michael Hanna: I’m not sure I understand your question. Are
you asking me if – how you should get the medical records from
the physician?
Michael Hanna: Yes.
Female: No. If the physician it’s my understanding that the
physician does not have to give us the medical records unless
there is an audit correct?
Michael Hanna: And then your detail written order would
indicate which type of manual wheelchair base you provided to
the beneficiary.
Michael Hanna: Yes. That was one of the clarifying changes that
came out April 28.
Female: Okay. So the five element order can just say
“wheelchair” and our DWO would specify whether it was
standard or lightweight?
Female: Okay. So if the patient now has a new physician
because they have Medicare primary, and they are on an E0784,
and the claim happens to be audited, and the new physician
hasn’t been seeing the patient for six months would we go back
to the old physician to get the face to face?
Female: Okay.
Michael Hanna: Correct.
Female: Okay, perfect. Thank you.
Michael Hanna: Yes ma’am.
Michael Hanna: I would assume so because if you don’t have any
records from the new physician you can only get medical records
if they’ve been seen by a doctor. Who is the NPI on the claim, the
new physician?
Female: Yes.
Page 8
Operator: And next caller please, go ahead.
Female: Hi. My question is I’m trying to figure out I understand
that both the Affordable Care Act and LCD requirements must
be met separately in order for a claim to be paid. My question
Originated June 8, 2016
© 2016 Copyright, CGS Administrators, LLC.
Ask-the-Contractor Teleconferences (ACT)
Ask the Contractor Teleconferences (ACT)
is when can we anticipate the LCD being updated to match
the April 28 revision because as of late the LCD still clearly
states that you need written orders prior to delivery with seven
elements and face to face documentation?
Michael Hanna: I don’t have a specific date for when the LCDs
will be updated and published. You should refer to that April 28,
2016, article. The medical directors are furiously working on that
as we speak. Simply put, there are a number of LCDs affected
so it’s probably going to take a few weeks. Again – the April 28,
2016, article is your “go to” resource at this time, if you will.
Female: Okay. Okay then I understand, thank you very much.
Michael Hanna: Yes ma’am.
Operator: Next caller please go ahead.
Female: Yes. I had a question about the five element order. And if
you have for instance a CPAP does that have to list every single
thing like the mask, and the tubing and the headgear does all of that
have to be on there or can it say “CPAP, humidifier, and supplies?”
Michael Hanna: That’s acceptable. The supply or accessory
items for PAP were never part of ACA 6407 only the device. If
you have a five element order that says “CPAP with headgear
and other accessories” that’s perfectly acceptable. Then you
would follow-up with a detailed written order that includes the
PAP – most likely include what the pressure settings should
be every accessory item for the PAP device the beneficiary
received along with their frequency of replacement.
Michael Hanna: I don’t know. You would have to ask CMS that
question. CMS is the one that provided the clarification to us.
Female: Because you would not otherwise know if the person
who was an NPI is listed it matches the name that signed.
Dr. Robert Hoover: Those are the five elements that are listed in
the regulations. CMS wrote the regulations.
Female: Okay. So they might . . .
Female: It might have had an oversight? Okay. And for the
question about the face to face and the LCD we might not be
required to have it on file before delivery but unless you read the
content of the face to face prior to the sleep test you would hardly
know if the patient was assessed for obstructive sleep apnea or
one of the qualifying symptoms unless you’ve actually had access
to view the notes and be able to determine that they had some
kind of content that would allow a sleep study to be ordered?
Michael Hanna: My reference was to ACA requirements overall
not just PAP. If part of your business practice is to ensure that the
beneficiary meets all requirements for a PAP device then you’re
definitely free to try to get that face to face evaluation up front.
Female: And the prior well the caller about three calls prior had
mentioned that there might be some practitioners unwilling to
share that documentation with a DME provider unless they saw
that you had active audit on the claim which means that the
claim has already been billed?
Female: Okay, perfect. Thank you.
Michael Hanna: That would be a business decision that you
have to make on how to work with that physician.
Michael Hanna: Yes ma’am.
Female: Thank you very much.
Operator: Next caller please go ahead.
Michael Hanna: Yes ma’am.
Female: Hi Michael, I had another question. Are the other
auditing entities following this five element order like the CERT
and the ZPIC?
Operator: And we’ll move on to our next question. Caller
please go ahead.
Michael Hanna: I don’t know for sure, but I know this is
published across the board on April 28, 2016, so you do have
that document as a reference. If you receive a denial from one of
these auditing agencies you do have appeal rights. You should
follow through by filing a redetermination at CGS.
Female: Okay, thank you.
Michael Hanna: Yes ma’am.
Operator: And moving on, next caller please go ahead.
Female: Thank you very much. On the documents that you
referred to on the April letter it states that the physicians NPI
should be one of the elements of the order. It does not include
the physician’s name. Why would that have been left off of the
five element order?
Page 9
May 25, 2016
Female: Hi. I have a question in regards to the RAD policy.
I have a client I know that ultimately the frequently asked
questions online should say that the face to face to the sleep
study time frame is normally three months, it’s not exactly
specified. I have an entity that the sleep lab is booked up like a
year in advance and the timeframe is really off. The face to face
was completed in March 2015.
And then the first sleep study happened in October 2015. And
then they had a repeat titration December 2015. What are my
options for the ASV E0471 and I’m just now getting the order to
provide the equipment?
Michael Hanna: The ACA requirements state they must have
a face to face evaluation within six months of the orders and it
sounds like that did not happen according to your example.
Female: Right.
Originated June 8, 2016
© 2016 Copyright, CGS Administrators, LLC.
Ask-the-Contractor Teleconferences (ACT)
Ask the Contractor Teleconferences (ACT)
Michael Hanna: You’d have to start over.
Michael Hanna: No . . .
Female: Okay. So the patient would need to go back for a new
face to face and a repeat sleep study?
Female: Okay.
Female: Okay. That’s what I needed.
Michael Hanna: . . . because wheelchair seating a valid detail
written order prior to delivery as part of the LCD not part of the
ACA. So your bed example is okay but your wheelchair seating
example is not acceptable.
Michael Hanna: Because even though LCD requirements were
met, ACA requirements were not met.
Female: So then “lightweight wheelchair” for example that would
be okay because that DWO was not part of that LCD policy?
Female: Now what do I do if as I would say with this entity
they’re never going to hit that six month timeframe from face to
face. Would it just be they need to reschedule a new face to face
and try to match the face to face with the sleep study?
Michael Hanna: Correct.
Michael Hanna: That is correct.
Michael Hanna: I think that would be advisable. I can’t tell you
how to run the business or your patients.
Female: Right.
Michael Hanna: But if the sleep study is a year out then we
definitely need to schedule the face to face encounter within six
months of the anticipated sleep test and eventual orders being
written if the item is part of the ACA.
Female: Okay, thank you.
Michael Hanna: Yes ma’am.
Operator: And we’ll move on to our next question. Caller please
go ahead.
Female: Hi. Can you please tell me if the five element order can
be verbal or must it be written?
Michael Hanna: It must be written because one of the elements
is the physician signature.
Operator: And we’ll move on to our next caller. Please go ahead.
Female: Hi Michael. I have a question in regards to the 5EO
and the description of the item. So our physicians have been
working diligently to produce a valid ACT compliant DWOPD
where they have specifically list, you know, semi-electric bed
with mattress and rails. When we’re doing a 5EO and they are
putting something down specific that could be tied to a specific
HCPCS code is it then okay to dispense an additional product
like let’s say they need now in EO294 instead of the EO260 and
then secure a DWO prior to billing?
Michael Hanna: That should be acceptable.
Female: Okay. So if it’s written for a general use seat cushion
or E2601 and I have medical documentation showing a skin
protection cushion is needed I can dispense, get the DWO for
the E2603 and bill?
Page 10
May 25, 2016
Female: Okay, thank you.
Michael Hanna: For manual wheelchairs, if I have an order for
a “lightweight wheelchair” and it turns out that the beneficiary
really requires a high strength lightweight then your “high
strength lightweight wheelchair” would be what was on your
detailed written order.
Female: Perfect. Thank you very much.
Operator: And we’ll move on to our next question. Caller please go
ahead. Caller please go ahead your line is open. And not hearing a
response we will move on to our next caller. Please go ahead.
Female: Hi. I wanted to go back to the question where the
lady asked about the patient who became Medicare and she
was talking about the other physician had seen them within
the six months but then they became Medicare. We have had
issues where customer service is telling us that the face to
face has to occur during the time that, that patient is Medicare
eligible. So like if they had a face to face in March and then
they became Medicare in May then they had to have a face to
face during that May period after becoming Medicare.
Michael Hanna: This is from an LCD aspect or from an ACA aspect?
Female: Well both really.
Dr. Robert Hoover: It doesn’t matter. There is no requirement
that the face to face be done while there – there just has to be
a face to face exam within the six months before the order was
written that describes the condition that would be related to the
item being dispensed.
Female: Okay. So you’re saying it doesn’t matter whether it is
related to LCD or the . . .
Dr. Robert Hoover: No. Your specific question asked “does the
exam have to occur by someone – while somebody was on
Medicare or eligible for Medicare.”
Female: Right.
Dr. Robert Hoover: And I’m saying no it does not.
Originated June 8, 2016
© 2016 Copyright, CGS Administrators, LLC.
Ask-the-Contractor Teleconferences (ACT)
Ask the Contractor Teleconferences (ACT)
Female: Okay. All right well we were told differently by
customer service.
Dr. Robert Hoover: I’m sorry you got that information.
Female: Thank you.
Operator: And we’ll move on to our next caller. Please
go ahead.
to be completed or not. There’s a section under date and timing
requirements it says, “The date of the face to face must be on
or before the date of the five element order may be no older
than six months prior to the five element order date. The date of
the face to face must be on or before the date of delivery. The
date of the five element order must be on or before the date of
delivery and the DME POS supplier must have documentation
of their completed five element order in their final prior to deliver
these items.” So it’s silent on whether the medical record has to
be complete and finalized.
Female: Hi Michael. Can you hear me?
Michael Hanna: Yes ma’am. Go ahead please.
Female: Okay, quick question. In regards to equipment such
as a bed and a wheelchair where there’s not any type of face
to face restrictions in the LCD I know with this new change we
don’t have to have the face to face in hand prior to delivery only
if audited but what if once audited and we request that face to
face and the signature data on the face to face is then after your
set up date?
Female: So we’re to assume that means that doesn’t play a part
in this then? It can be . . .
Michael Hanna: I will reach back out and see if we get some
clarification on that one before we finish the transcript. I’ll just
add a note when that transcript’s published.
NOTE: There has been no clarification from CMS to the DME
MACs on whether the face to face encounter medical record has
to be completely finalized (i.e., transcribed and signed) prior to
delivering the equipment.
Michael Hanna: Then you would likely lose that audit.
Female: Okay. So the signature date still has to be – those notes
still need to be signed prior to set up day not the date patient
was seen. I know that has to be prior to set up but the date the
doctor signed the note.
Female: Perfect. Okay, thank you.
Michael Hanna: Thank you for the question. I appreciate it ma’am.
Female: Thanks.
Michael Hanna: Do you mean the record – the visit took
place versus when the electronic health record was actually
transcribed and completed or whatever the case may be?
Operator: And we’ll move on to our next caller. Please go ahead.
Female: Correct.
Michael Hanna: Okay.
Michael Hanna: Is that your question?
Female: The first part is thus far CGS and the other MACs have
not actually been looking for and enforcing the face to face
criteria as far as making sure that there was a face to face within
six months even though it’s been in effect since July of ‘13. Can
we now expect that they will be actually enforcing that part in the
auto process and any other time?
Female: Yes. I know the visit date obviously has to be prior to
set up. I just wasn’t sure if this is going to change that the doctor
must electronically sign or however he signs his notes prior to
set up?
Female: Hi. I have a two-part question about face to face.
Michael Hanna: If we have evidence a visit took place prior
to the orders then I think we would be okay. I’m going back
out to that article right now to take a look at it to read what the
language from CMS has.
Michael Hanna: No. The DME MACs have yet to receive
information from CMS to begin enforcing that part of Section 6407.
Female: So we have several doctors now that might be months
or so to review and go back and find them.
Michael Hanna: I do not. No ma’am.
Operator: Are you ready to move on to your next question?
Michael Hanna: Yes, I’m still looking at this. And (Rochelle) I just
wanted . . .
Operator: Oh okay, thank you.
Michael Hanna: . . . to briefly glance over the article. I’m sorry
for my silence. That article is silent on whether the record has
Page 11
May 25, 2016
Female: Okay. And we don’t have an expected date still?
Female: Okay. And the other part was it – the way they write to
the physicians that whole change where they’re talking about
the treating physician and then they refer to practitioners. So
and it talks about how they have to be evaluated and treated
for a condition. So my patient goes to the doctor follow-up from
the hospital for a broken hip and he’s like yes, yes I think the
patient needs a wheelchair but the clinical documentation the
medical necessity that meets the LCD is written by a physical
therapist that he has access to those records does that qualify?
Is that going to qualify because my understanding was that the
Originated June 8, 2016
© 2016 Copyright, CGS Administrators, LLC.
Ask-the-Contractor Teleconferences (ACT)
Ask the Contractor Teleconferences (ACT)
physician is going to have to do soup to nuts for the whole thing
for the whole LCD?
Michael Hanna: A physical therapist is not considered a
physician in Medicare’s eyes. However, their records could play
a role. The physician could reference the physical therapist
examination as part of it. The actual MD, if you will, would be the
individual that completes and signs a face to face encounter. But
if the physical therapist evaluation records are also provided to
the auditing entity, they would be reviewed.
Female: Right. I guess what I’m asking is if he says, you know,
I’m seeing the patient today for a wheelchair because they’ve
had – they just broke their hip but he doesn’t say anything
about the ADLs and needing it for more than two hours or what
– anything that’s, you know, he wants specific to the LCD but a
physical therapist documented that for him prior to the patient
being seen by him like in between.
You know, the patient was in the hospital for the hip fracture, got
out. Then the face to face occurs and then that’s where we’re
going to end up providing the wheelchair. Just as an example is
that going to be okay that he didn’t write the patient is going to
need that wheelchair to complete their ADLs and so on and so
forth if the PT – if a physical therapist or somebody else did that
for him a clinician?
Operator: And as a reminder to ask a question please press star
followed by the digit 1. And we’ll move on to our next question.
Caller please go ahead.
Female: Thank you. Can you hear me?
Michael Hanna: Yes ma’am.
Female: Thank you Michael. I’m still referencing Chapter 3 of
the Supplier Manual. Page 17 has not reflected the change.
It still reads that we must have both the face to face and the
documentation of the written order prior to delivery in our
records. Are they going to be making a change soon in the
supplier manual?
Michael Hanna: Yes. The Supplier Manual and LCDs will be
updated. In the interim reference the April 28, 2016 article.
Female: Yes, the one that still does not include the physician’s
name with the NPI? Okay, thank you.
Michael Hanna: Yes ma’am.
Operator: And we’ll move on to our next question. Caller please
go ahead.
Male: Michael, can you hear me?
Michael Hanna: Yes. The physical examination records by the
physical therapist could be submitted with the physician’s face to
face encounter.
Female: Okay.
Operator: And we will move on to our next question, caller
please go ahead.
Female: I was wondering if you can comment on question
Number 12 of the Q&A. The question reads “what date should
be used for the date of the order on the five element order?” The
answer is “use the date the supplier is contacted by the treating
practitioner in parentheses for verbal orders or the date entered
by the treating practitioner for written dispensing orders.”
Michael Hanna: What did you want me to comment on that
about ma’am?
Female: Well I’m sorry. If one of the requirements is signature
of the practicing or prescribing practitioner why does the answer
reference verbal orders?
Michael Hanna: I don’t know why the answer references verbal
orders.
Page 12
May 25, 2016
Michael Hanna: I can. How are you doing today?
Male: Well sir listen wouldn’t it be a little simpler for us DMEs
just to add the five element order to what we’re doing now
instead of starting – changing and saying that, you know, this is
not required here it’s required here. Wouldn’t it be just simple to
just add the five element order to what we’re doing now all the
face to face documentation just add that . . . ?
Michael Hanna: I told a previous caller if your referral sources
are used to providing a detailed written order prior to delivery as
long as it includes the NPI then you’ve met the elements for that
five element order.
Male: Yes. We always try to do it. And another thing on the “Dear
Physician” letter I think you said that Medicare was not has not
sent those to the physicians yet and was leaving it up to the
DMEs to educate our physicians. That’s kind of like pulling hen’s
teeth. It seems like to me Medicare would put the same weight
on the physicians as they put on us.
Michael Hanna: The physicians are audited. Those “Dear
Physician” letters are simply another tool that the DME supplier
community has to help physicians understand some of the
requirements from the DME perspective.
Dr. Robert Hoover: Because a physician could call in a verbal
order dispensing order, you prepare it and send it back to them.
Male: Okay. Thank you much.
Female: Thank you.
Michael Hanna: Yes sir.
Michael Hanna: Thank you Dr. Hoover.
Operator: And next caller please go ahead.
Originated June 8, 2016
© 2016 Copyright, CGS Administrators, LLC.
Ask-the-Contractor Teleconferences (ACT)
Ask the Contractor Teleconferences (ACT)
Female: I’m sorry actually my question has been answered.
Operator: And we’ll move on to our next question. Caller please
go ahead.
Female: Hi. I had a question related to the manual. You stated
that the manual will be updated but in Chapter 3 the language
in the face to face examination you state that we’re backing off
some of the requirements of the face to face a little and they’re
still not enforceable. But it – is it still – is the language still
going to be in the manual that states other auditing entities may
enforce these requirements for the face to face?
Michael Hanna: Yes, that is still valid. The CERT contractor has
been enforcing the face to face aspects since the Affordable
Care Act was passed because it’s federal law.
Female: Okay. So basically even though you’re not requiring
it in advance to – the requirement to have it in advance before
delivery still applies to CERT?
Michael Hanna: I don’t know. I can’t answer for the CERT
contractor. They’re a completely different entity with their own
contract with CMS. So I would be unable to answer that question.
that. Assuming that your electronic health record is very clearly
marked with an electronic date then there shouldn’t be a denial
for not for having not having a physical ink stamp date on it.
Female: Wonderful. That is the best and clearest answer I’ve
ever received because I keep asking the question and nobody
can answer. I appreciate that. Thank you.
Michael Hanna: Do you have . . .
Dr. Robert Hoover: We have a number of articles out on our
website that talk about date of receipt and marking date of
receipt. It’s why we always say date stamp or equivalent is that
we do accept fax headers although there are some issues with
fax headers being cut off or partially received. But there are
multiple ways to indicate receipt date. It’s not just a physical
stamp to date on a document.
Female: Well and I have to be honest here, you know, I’m – we’re
going to be coming to you guys. You’re going to be our new
contractor July 1. I’m from the other region and that’s how they’ve
been handling this. So I wanted to present this question because
we will be with you guys shortly and seeing how you’re going to
handle these audits. So it’s very encouraging that you understand
the electronic record and how that’s working in our case.
Female: Okay, thank you.
Operator: And next caller please go ahead.
Female: Hi. I have a question in regard to date stamping in general.
We are a hospital based DME. And we can see fortunately,
you know, all of the face to face documentation in the patient’s
electronic medical record. And we receive a lot of our referrals from
our providers electronically. So it’s very clear to see the – and we
have templates set up where the physician does a detailed written
order with the NPI and all of the elements on it, sends it to us
electronically, we continue to chart in the patient’s electronic medical
record that we received that order, we reviewed the documentation
and we consider it valid or invalid and proceed from there.
But when we submit this charting for our audits it’s denied
as no physical date stamp although everything and all our
documentation is electronically date stamped in the electronic
medical record as we go along. So what we’ve had to do
because our billing software is different than the electronic
medical record that everybody is sharing then we have to print
that off, put a physical stamp on it which we all know can be
manipulated versus electronic documentation that’s happening
right before our eyes. Why isn’t that valid and acceptable or
being considered as an equivalent to a date stamp?
Michael Hanna: I don’t know how I could answer that. I’m not a
clinician that reviews claims.
Dr. Robert Hoover: It is – Michael it is valid or equivalent to.
You shouldn’t have to drop it to paper and put a physical date
stamp on it. If that is something that is happening with a CGS
audit then I suggest you get in contact with Michael and he can
do some research and we can find out which of our staff is doing
Page 13
May 25, 2016
Michael Hanna: Do you have my contact – well since the claims
aren’t coming to CGS yet I’d have no way to look at them.
Female: Right.
Michael Hanna: I would wait until after the transition. And . . .
Female: Sure.
Michael Hanna: . . . then we’ll move forward from there ma’am
because at CGS we have no way currently to look at any
medical records.
Female: I understand. I was just trying to get a peek into your
thought process for the future, and I appreciate your time.
Michael Hanna: Thank you ma’am.
Operator: And there are no further questions at this time. If
you’d like to ask a question please press star followed by the
digit 1. And we’ll move on to our next question. Caller please
go ahead.
Female: Hello. Can you hear me?
Michael Hanna: Yes ma’am. Go ahead please.
Female: Hello. On the five element order is it possible for the
dispensing order to also be considered the five element?
Michael Hanna: From a standard language arena . . .
Female: Yes.
Originated June 8, 2016
© 2016 Copyright, CGS Administrators, LLC.
Ask-the-Contractor Teleconferences (ACT)
Ask the Contractor Teleconferences (ACT)
Michael Hanna: . . . a dispensing order is not the same as a five
element order. They don’t have the same elements. So I guess
technically . . .
an NPI they would have to be cosigned by their supervising
physician as well as, as I noted before state laws might play a
role there.
Female: If all the elements were on the dispensing order would
it – could it be considered the same?
Female: Thank you.
Michael Hanna: Then it’s a five element order. I try to not
educate that way, but those terms are used synonymously.
We educate with the five element order is at a minimum
necessary for items as part of the Affordable Care Act section
6407. And the dispensing order is acceptable for items that
are not part of the ACA like a walker, or a commode chair or
something like that.
Female: Okay. So like a doctor calls in for a manual wheelchair
and the manual wheelchairs are part of the ACA Affordable Care
Act. They call in a verbal order. And we send them a dispensing
order to verify what they want us to deliver. That would not be –
we would not be able to use that as a five element order?
Michael Hanna: I would say instead of sending them a
dispensing order you would send them a five element order.
Female: So we can go ahead and create the five element order
not like on the PMDs on a seven element order the doctor has to
handwrite it?
Michael Hanna: That’s correct because power mobility is its own
category and they are not part of the Affordable Care Act.
Female: Okay. I’m just – thank you for that clarification. Also just
wanted to remind everybody that, you know, just because the
DME MACs may not be auditing for a particular documentation
the CERTs will. So if your face to face may not be necessary for
Medicare it will be necessary for the CERT if you get audited.
That’s just a reminder. Thank you all.
Operator: And we’ll move on to our next caller. Please
go ahead.
Female: I’d like to ask the question if a PA or a nurse practitioner
does the face to face does the supervising physician have to
sign off on the chart notes?
Michael Hanna: Not in Medicare guidelines. You’d need to refer
to state law in that situation. Medicare considers a physician’s
assistant or a nurse practitioner a physician in their eyes. And
they can write orders as long as they have a valid NPI.
Female: So are you saying there the physician does not have to
cosign the visit notes?
Michael Hanna: Not for Medicare guidelines but you need to
refer to state law. If the NP or PA is treating that beneficiary for
the condition that requires the equipment in Medicare’s eyes
those medical records and the subsequent orders are valid.
They can be signed by the NP or PA. They do not need to be
cosigned by the MD. However, if that practitioner does not have
Page 14
May 25, 2016
Male: Therapeutic shoes are still carved out of that, is
that right?
Michael Hanna: I’m sorry.
Male: Therapeutic shoes would still be separate? Still need an
MD or DO?
Michael Hanna: It’s all – therapeutic shoes are not a part of the
Affordable Care Act.
Male: Yes.
Michael Hanna: All LCD and related Policy Article requirements
for diabetic shoes are still in play. That has nothing to do with
information on this call.
Male: Okay, thank you.
Dr. Robert Hoover: But to answer your question, yes for
therapeutic shoes for persons with diabetes, the certifying
physician must be an MD or DO and can’t be a nurse
practitioner, a PA or a CNS.
Male: Thank you.
Operator: And as a reminder it’s star 1 to ask a question. We’ll
move on to our next question. Caller please go ahead.
Female: Yes. I was going to refer to what that lady just said was
that’s what I had. On the CERT audits that we get when we have
to do the - they have to have the face to face prior to delivery
and has to have the dates stamped. And you get 49 nebulizer
audits and you got to send all that in and then they deny you
because you haven’t got the date stamp then you’d have to send
it to redetermination at Medicare and they’ll turn around to give
you money back. So we’re really not changing anything are we?
Michael Hanna: Did you have a question ma’am?
Female: Yes. My question is the date stamp that you having
to do on the – that you don’t have to do any more is really not
relevant because you really need to do it because the CERT
audit you’re going to have to do it.
Michael Hanna: I reiterate, the CERT and you mentioned the
49 audits that probably comes from a supplemental medical
review contractor – I have no response now on how they’re
going to review moving forward, time will tell. They are separate
contractors with CMS.
Female: Well they need to change their rules too because it’s
crazy if you don’t require and they’re checking what you’re
Originated June 8, 2016
© 2016 Copyright, CGS Administrators, LLC.
Ask-the-Contractor Teleconferences (ACT)
Ask the Contractor Teleconferences (ACT)
May 25, 2016
doing and they’re – why would they not change their rules too?
Michael Hanna: I don’t have a response ma’am. Did you have
another question?
Female: No I don’t.
Operator: And we’ll move on to our next question. Caller please
go ahead.
Male: Yes I have in reference to a prescription that we get. And
if it just says “wheelchair” but the patient needs a heavy duty
wheelchair does it have to specify that or does it or do they just
write that in the DWO?
Michael Hanna: That would be applicable for the detailed written
order.
Male: Okay. So even though they just write “wheelchair” as
long as they’ve stated that its heavy duty in the detailed written
order it’s fine?
Michael Hanna: Yes.
Male: Okay. And as in for a hospital bed as well?
Michael Hanna: Correct.
Male: Okay, all right. That’s all I needed.
Operator: And there are no further questions at this time. As a
reminder it’s star 1 if you would like to ask a question. And caller,
please go ahead.
Female: My question goes back to something that I’ve already
asked at the Charlotte meeting but I haven’t heard today. If you
get a dispensing or you get an order a five element order that
says “oxygen,” can you dispense portable oxygen? And then get
your CMN in for your detailed written order prior to billing?
Michael Hanna: Yes, that’s acceptable.
Female: Okay, thank you.
Operator: And at this time there are no further questions.
Michael Hanna: I’m not hearing anything else, (Rochelle).
We’ll go ahead and let you complete this call for us. We thank
everyone for your attendance and participation this afternoon.
We will alert you via a ListServ announcement when the
transcript gets uploaded to the CGS website. Thank you so
much. You have a wonderful afternoon. And thank you, Dr.
Hoover for your input. I do appreciate that as well.
Operator: And that will conclude today’s call. We thank you for
your participation.
- END -
Page 15
Originated June 8, 2016
© 2016 Copyright, CGS Administrators, LLC.