The Face-to-Face You Have to Produce Five Years Later
CMS wants to stop requiring a new face-to-face encounter for identical DMEPOS replacements, and says the fiscal impact cannot be estimated. On audit you still produce the original encounter, which can be 66 months old, from records nobody has to keep past month 84. Comments close tomorrow.
Buried at 91 FR 41282, inside a home health rate rule, CMS explains why it cannot put a number on one of its own proposals.
The reason it gives is that nobody measured the problem. The rule exists because "varied medical review decision-making and the need for this clarification was identified anecdotally."
That is the agency's own sentence, in the regulatory impact analysis, about a change to a condition of payment.
The proposal is section V.B of CMS-1844-P, the CY2027 home health rule published July 6. It would add a new paragraph to 42 CFR 410.38 saying that a replacement DMEPOS item does not need a new face-to-face encounter. Comments close tomorrow, August 31, 56 days after publication, with 292 comments on the docket as of this morning.
If you bill wheelchairs, orthoses, ventilators or oxygen, this is the rule that decides what your medical review packet has to contain in 2027. It is also the rule that quietly makes that packet older.
What The Proposal Actually Does
Today, 410.38 conditions payment on two things for items CMS has selected: a written order communicated to the supplier before delivery, and documentation that the ordering practitioner had a face-to-face encounter with the beneficiary in the 6 months preceding that order. The requirement bites only on codes CMS has placed on the Required Face-to-Face Encounter and Written Order Prior to Delivery List by Federal Register notice.
The proposal drops the second one for replacements. CMS's words: "while an order would continue to be required for replacement DMEPOS items, a new face-to-face encounter would not need to occur to support payment for these DMEPOS items."
So the written order survives.
Every coverage instruction survives too, and CMS says so directly: the clarification "does not eliminate the need for a new order, nor does it supersede or eliminate any other coverage instruction, including those iterated in national or local coverage determinations." If you read a summary that said the WOPD goes away, it was wrong.
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