LEEDer Group Inc.
8508 North West 66th St.
Miami, Florida 33166 USA

Phone: 305.436.5030
Fax: 305.436.0086
E-mail Address: info {at] LEEDerGroup [dot] com

2014-08 ACA 6407 Requirements – Corrections and Amendments to the Face-To-Face Visit and Written Order Prior to Delivery (WOPD)

KYDEX-PRO

STRONGER

SAFER

LEEDerGroup.com

August 28, 2014
Replaces “Written Order Prior to Delivery – Corrections to Document” article previously published on August 7, 2014

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

Joint DME MAC Article
August 28, 2014

Replaces “Written Order Prior to Delivery – Corrections to Document” article previously published on August 7, 2014
ACA 6407 Requirements – Corrections and Amendments to the Face-To-Face Visit and Written Order Prior to Delivery (WOPD)

Joint DME MAC Article

  • The Affordable Care Act §6407 requires that the treating physician conduct a face-to-face examination and provide a written order prior to delivery (WOPD) for certain items of durable medical equipment (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.
  • If errors in the face-to-face visit documentation or WOPD are found prior to delivery, the supplier has two options:
    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 Program Integrity Manual (Internet-Only Manual, Publ. 100-08, Chapter 3, Section 3.3.2.5) ; or,
    A new face-to-face examination may be conducted or a new WOPD may be created, whichever is applicable.
  • 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:
    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 re-deliver the item(s) to the beneficiary; or,
    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.