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Anyone order DME with the new rules - no doc signature?


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Guest Paula

I ordered oxygen today, no co-signature was asked for by the company.  They in fact called back because they were so ecstatic that I documented the face to face visit the right way, used the right words and documented the O2 sats correctly.  

 

I'm waiting for a box of thank you chocolates.

 

I ordered something else, can't remember what it was now....maybe was a cane??? No co-sig asked for. 

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Has this been implemented already?  Excuse my ignorance, but there is usually a delay between passage and rule-writing, then implementation.  I don't want to pick an argument with medical supply company and find out I was wrong.  Thanks!

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Guest Paula

I got the final paper work back on my 02 order that needed my original signature.  I did not have the physician co-sign so it will be interesting to see if it is back on my desk Monday morning.  I did not think about a delay with implementation.   

 

I really wish when these things get passed that someone would give us these type of details!

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  • Moderator

as hx

 

we used to be able to order

 

then a few years ago congress said it had to be a Doc - trying to fight fraud but overlooked us

 

now they changed it to PA.NP.MD.DO

 

 

Law trumps regulation so it should have taken effect immediately upon signing unless there was roll out time frames in the law

 

 

I just got a request for a power chair that I signed and returned, will see if it gets kicked back

 

 

 

 

 

WE MUST ADVOCATE TO GET THE ABILITY TO ORDER VNA AND HOSPICE

 

CONTACT YOUR REP'S TO GET THE PASSED

 

SEE AAPA POLITICAL ACTION PAGE FOR THE EASY WAY TO DO IT

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Law trumps regulation so it should have taken effect immediately upon signing unless there was roll out time frames in the law

 

 

This is the kind of thing that AAPA should be telling us directly!  Where's my email on the subject?  I get other emails from them.  This is important to those of us on the front lines in the practice of medicine.  

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 Were there any changes to the ordering of home health for medicare beneficiaries by PA's and NP's? My friend is an RN for one of the largest home health services in Washington state and has told me all about the ridiculous loopholes when a PA/NP orders home health. For example, they can take a verbal order from a PA/NP for home health, but if the provider sends a written order it must be signed by the attending physician. 

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No law changes on the home care or hospice, BUT

 

AND this is a big BUT

 

There is once again a bill before congress in both the house and senate that is designed to add PA and NP to those that can order. 

It has wide support, is gaining co-sponsors every few days but 

 

YOU ALL NEED THE WRITE/CALL/CONTACT YOU REPRESENTATIVES IN DC!

 

AAPA has made this VERY easy to at least send a form email - which honestly does close to nothing..... but better then nothing....

 

 

http://capwiz.com/aapa/home/

 

is all you have to do

 

 

 

BUT even better, take 15-20 min and call into you congress people and ask to speak to their specialist on health care and just explain to them that you would like them to support these bills

 

 

hospice 

http://capwiz.com/aapa/issues/alert/?alertid=64205611

 

VNA

http://capwiz.com/aapa/issues/alert/?alertid=64206866

 

 

 

more links on one page

 

http://capwiz.com/aapa/issues/?style=D

 

 

 

 

 

 

 

 

 

 

 

Even if you never order VNA or hospice, make a call for your fellow PAs that are being held back by senseless outdated regulations......

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  • 4 weeks later...
  • Moderator

UPDATE

 

 

So had my first order for a patient after this law passed

 

 

 

Guess What

 

 

Pharmacy denied based on no co-sign by a doc !!!

 

I have previously spoken with and explained to them the new law.......  They stated that since they enacted a system to comply with the old law, even though enforcement was suspended!, that the new law did not apply to them as they have to wait for it to be enacted!!!  WHAT

 

I have already spoken to both of my senator's offices, and am reaching out here to ask if anyone else has experienced this? 

 

 

This is just stupid and insulting and a classic example of the stupidity in business!

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this is the actual law

 

 

SEC. 504. MODIFYING MEDICARE DURABLE MEDICAL EQUIPMENT FACE-TO-FACE ENCOUNTER DOCUMENTATION REQUIREMENT.

(a) IN GENERAL.—Section 1834(a)(11)(B)(ii) of the Social Security Act (42 U.S.C. 1395m(a)(11)(B)(ii)) is amended—

        (1) by striking ‘‘the physician documenting that’’; and  

        (2) by striking ‘‘has had a face-to-face encounter’’ and inserting ‘‘documenting such physician, physician assistant, practitioner, or specialist has had a face-to

             -face encounter’’.

(b) IMPLEMENTATION.—Notwithstanding any other  provision of law, the Secretary of Health and Human Services may implement the amendments made by sub-section (a) by program instruction or otherwise.

 

 

full law  

https://www.congress.gov/114/bills/hr2/BILLS-114hr2ih.pdf

see page 223 for the above paragraph

 

 

 

As the only way to reach the Sec that I could find was twitter I have posted a few tweets to her account at  @SecBurwell to see if they get to her

 

We all should reach out to the her

this is her home page http://www.hhs.gov/about/leadership/secretary/index.html

 

does anyone have any other contact info??

 

 

 

 

They are hiding behind that (b)

 

Oh this is such an enormous stupid waste

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Guest Paula

My orders for oxygen and a wheelchair have been returned for doc co-signatures too.  The Home Medical Supply agency told me that they couldn't implement the new law until CMS updated their manual. They check every Monday as apparently that is the date that updates are done.  

 

The Home Medical supply company was thrilled with the new law and are frustrated as the PAs and NPs in my group. 

 

This is the time for AAPA to step in and make a difference and they need to talk to SecBurwell asap.  It sounds like it is in her court.  

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Guest Paula

I checked out Sec Burwell's page.  I found a section where one could make comments on rules and regulations that need to be updated.  I made a comment on designating PAs as LIPs.    It's a different issue but I decided to take the opportunity.  More PAs should do the same! 

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  • 3 months later...

No law changes on the home care or hospice, BUT

 

AND this is a big BUT

 

There is once again a bill before congress in both the house and senate that is designed to add PA and NP to those that can order. 

It has wide support, is gaining co-sponsors every few days but 

 

YOU ALL NEED THE WRITE/CALL/CONTACT YOU REPRESENTATIVES IN DC!

 

AAPA has made this VERY easy to at least send a form email - which honestly does close to nothing..... but better then nothing....

 

 

http://capwiz.com/aapa/home/

 

is all you have to do

 

 

 

BUT even better, take 15-20 min and call into you congress people and ask to speak to their specialist on health care and just explain to them that you would like them to support these bills

 

 

hospice 

http://capwiz.com/aapa/issues/alert/?alertid=64205611

 

VNA

http://capwiz.com/aapa/issues/alert/?alertid=64206866

 

 

 

more links on one page

 

http://capwiz.com/aapa/issues/?style=D

 

 

 

 

 

 

 

 

 

 

 

Even if you never order VNA or hospice, make a call for your fellow PAs that are being held back by senseless outdated regulations......

Message sent and shared with my colleagues! Our clinics are scattered out over a wide area and we have 1 doc for all of us. The paperwork burden and delay in care getting co signatures is significant for us.

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I've signed orders for walkers, wheelchairs and home oxygen without any issues. The first time I saw the paperwork from the social worker another PA that has been in practice longer said- "you can't sign that." I said, "yes I can! New rules!!" Signed it, we laughed and it never came back. And the social worker, who is awesome, agreed that my signature was enough. Our forms have been edited to say "provider" instead of MD/DO.

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