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ACA 6407 Requirements – Corrections and Amendments to the Face-To-Face Visit and Written Order Prior to Delivery

Joint DME MAC Article

The ACA Section 6407 requires that the treating physician conduct a face-to-face examination and provide a WOPD for certain items of DME. When the supplier receives the documentation of the face-to-face visit and it does not describe a medical condition for which the DME is being prescribed or the WOPD is defective (i.e., missing a required element), the following instructions describe the options for remedy.

  1. If errors in the face-to-face visit documentation or WOPD are found prior to delivery, the supplier has two options:
    1. The supplier may request that the treating physician amend the face-to-face visit notes or the WOPD, whichever is applicable, following the guidance in the CMS Medicare Program Integrity Manual (IOM, Publication 100-08, Chapter 3, Section 3.3.2.5); or,
    2. A new face-to-face examination may be conducted or a new WOPD may be created, whichever is applicable. 
  2. If errors in the WOPD are found or the face-to-face visit notes do not describe a medical condition for which the DME is being prescribed and this is discovered after delivery of the item, the supplier has two options:
    1. If the error is discovered prior to claim submission, the original supplier may recover the delivered item(s), obtain a compliant, complete WOPD or face-to-face visit notes that describes a medical condition for which the DME is being prescribed, whichever is applicable, and then redeliver the item(s) to the beneficiary; or,
    2. If the error is discovered after submitting a claim, the original supplier can recover their items and a new supplier must complete the transaction after complying with all requirements.

Because the face-to-face visit and WOPD are statutory requirements, if there is a defective WOPD or the face-to-face visit notes do not describe a medical condition for which the DME is being prescribed, the claim will be denied and a beneficiary liability determination applied. Suppliers are strongly encouraged to review their WOPD documentation and the face-to-face visit notes carefully prior to delivery to ensure that all the requirements for coverage are met.

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ACA 6407 Requirements – Corrections and Amendments to the Face-To-Face Visit and Written Order Prior to Delivery
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