ACA 6407 Requirements - Corrections and Amendments to the Face-To-Face Visit and WOPD - JA DME
ACA 6407 Requirements - Corrections and Amendments to the Face-To-Face Visit and Written Order Prior to Delivery (WOPD)
Joint DME MAC Article
This is revision to an article previously published on August 7, 2014 entitled "Written Order Prior to Delivery – Corrections to Document"
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 126.96.36.199); 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.
Last Updated Fri, 04 Nov 2016 14:23:44 +0000