CMS Proposes Relaxed Home Health Face-to-Face Encounter Requirements

The Centers for Medicare and Medicaid (CMS) on July 6 issued the proposed rule for 2013 payment rates. This proposal included revisions to home health face-to-face (F2F) requirements that will provide some relief to home health agencies, physicians, and non-physician practitioner in their efforts to be in compliance with certification requirements.

Revised Document Title Requirements

The greatest relief is the proposal to revise F2F regulatory language that led to a requirement that the titling of F2F encounter documentation be completed by the certifying physician. As a result of the current regulatory text at §424.22(a)(1)(v)(D) and CMS’ response in F2F Questions & Answers posted on the Home Health Center website, home health agencies have made every effort to ensure that F2F documentation is properly titled because failure to do so has resulted in claims being denied if the face-to-face documentation is not “clearly titled” by the certifying physician. Home health agencies continue to struggle to identify ways to ensure that physicians title F2F documentation, such as clinical notes, referrals and discharge plans. This requires returning documentation to already overburdened physicians with a request to affix a title.

In the notice of proposed rulemaking, CMS explained that its intent was that the face-to-face documentation be clearly titled, but not necessarily by the certifying physician. In order to affect the needed change, CMS is proposing to “amend …regulatory language so as to not be prescriptive as to what entity must title the documentation. The face-to-face documentation must still be signed by the certifying physician, and the content requirements are not changing.”

CMS is encouraging stakeholders to comment on the proposed change. The proposed regulation reads: “424.22 (a) 1 (v).. (B) The documentation of the face-to-face patient encounter must be a separate and distinct section of, or an addendum to, the certification, and must be clearly titled and dated and the certification must be signed by the certifying physician.”

Acute or Post-Acute Physician Flexibility

As a condition for payment, the Affordable Care Act requires that, prior to certifying a patient’s eligibility for the home health benefit, the physician must document that he or she, or an allowed non-physician practitioner (NPP) working in collaboration with the certifying physician, had a face-to-face encounter with the patient. As a result, CMS limits F2F encounter by NPPs to those working in collaboration with the certifying physician, which is usually the community physician. This regulation has limited of the role of inpatient NPPs in the conduct of F2F encounters.

The home health industry asked whether it would be acceptable for an allowed NPP working in collaboration with an acute or post-acute facility physician, to perform the face-to-face encounter and communicate his or her clinical findings to the acute or post-acute care physician who would then communicate them to the certifying physician in the community. In response to this request CMS has proposed that, for patients admitted to home health from an acute or post-acute facility, they will modify the regulations at §424.22(a)(1)(v) to allow an NPP working in collaboration with or under the supervision of an acute or post-acute inpatient physician to perform the face-to-face encounter, and allow that inpatient physician to inform the certifying physician in the community of the patient’s homebound status and need for skilled services. CMS is seeking comments on this proposed change as well.

NAHC Report will offer additional details on other topics in the proposed rule, including payment update, therapy assessment changes, and home health sanctions. The full text of the proposed rule and guidance for submitting comments can be found on display at: Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2013, Hospice Quality Reporting Requirements, and Survey and Enforcement Requirements for Home Health Agencies www.ofr.gov/OFRUpload/OFRData/2012-16836_PI.pdf until July 13, 2012 when it will be published in the Federal Register.

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