WOPD: Stakeholders still seek clarification on key issues

BALTIMORE - CMS began enforcing the written order prior to delivery (WOPD) requirement on Jan. 1, and providers, for the most part, say they're on top if it.

“We started moving ahead with that last July because we knew it was coming,” said Carter Fuller, vice president of business development for Chattanooga, Tenn.-based Professional Respiratory and Medical. “It was all about educating out in the community and getting in front of it.”

CMS in December announced that it would begin enforcing the WOPD requirement, part of CMS's face-to-face rule, on Jan. 1. The agency has twice delayed enforcement of the face-to-face rule to give providers more time to establish processes, but it expects to enforce the rule some time in 2014.

A major motivating factor in getting onboard with the WOPD requirement: audits. Gone are the days of providers fearing they will lose referrals to a competitor who isn't asking for lots of documentation.

“For the most part, everybody's singing the same story,” said Doug Coleman, CEO of Major Medical Supply in Fort Collins, Colo. “Because of audits, people are more quick to adapt to following the rules.”

Providers may be on top of things, but AAHomecare still seeks clarification from CMS on several issues. Chief among those: If the WOPD, which has far more elements than a dispensing order, is missing a piece of information like the physician's NPI number and it's not caught until after the equipment is delivered, does the provider have any recourse to fix it?

“It doesn't make any sense that if I deliver a bed and there's something wrong with the order, then the patient has to pay for the entire rental or another provider has to come in,” said Kim Brummett, the association's senior director of regulatory affairs. “If you've already delivered it, you can't fix the WOPD.”

As to the upcoming enforcement of the face-to-face rule, it's anyone's guess how smoothly that will go. One lingering concern is that, although nurse practitioners and physician assistants (PAs) may perform the face-to-face exam, only a physician can sign off on it. That could create access issues, particularly in rural areas, say providers.

“There's not enough doctors at our rural health clinic to see all the people, so we've got nurse practitioners and PAs seeing patients,” said Glenn Steinke, owner of Airway Medical in Bishop, Calif.