Nurses Want Patients to Get Needed Equipment Without Delays

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Given ongoing advocacy by the American Nurses Association (ANA) and nurses from across the nation, the Centers for Medicare and Medicaid Services (CMS) has again postponed a requirement that would have prevented nurse practitioners, clinical nurse specialists and other clinicians from ordering durable medical equipment for patients without first obtaining an extra layer of documentation by a physician.

The requirement is part of Medicare changes that were made to address concerns about potential fraud and abuse in ordering services for covered patients. In this case, Congress wanted to ensure that blank prescription pads weren't being used to generate claims for durable medical equipment, such as portable oxygen systems and home blood glucose monitors, for ineligible or nonexistent “patients.”

To that end, CMS developed a rule stating that before certain equipment can be supplied, there must be documentation that a face-to-face encounter occurred between a patient and the advanced practice registered nurse or other clinician ordering the needed equipment. That documentation must be signed by a physician.

ANA agrees with the importance of seeing patients face to face and documenting needed care. ANA also believes that reducing fraud is a laudable goal. However, this additional signature can cause unnecessary delays to patients needing the most basic and often critical equipment. Several items on the equipment list requiring the additional step are often and readily prescribed by a qualified and licensed advanced practice registered nurse.

Currently, enforcement of this provision is postponed until an unspecified date in 2014.

ANA will continue to advocate to address nursing’s concerns about this rule and its impact on patient care. For more information and to take action, go to