Is relief finally in sight for home health agencies on the face-to-face?
It should be no surprise to the home health industry, who have had reported losses of tens of thousands of dollars from inadequate face-to-face encounter documentation, that the face-to-face has been the recent focus of healthcare news, CMS and Medicare Home Health Part A Contractor communications, initiatives and trainings.
- In the first quarter of 2014, newsletters from the Medicare Home Health Part A Contractors reported over 80% of claim denials are related to face-to-face encounter requirements not being met and started providing recommendations to providers on how to avoid them.
- At the March on Washington, the National Association of Homecare (NAHC) announced a planned lawsuit against CMS which would include three arguments relating to the face-to-face:
- Argument that the requirement for the physician narrative is outside of CMS authority and that the ACA provides that a physician must only document that the encounter occurred.
- Argument that CMS has not established standards for compliance that can be adequately understood and applied by physicians and home health agencies.
- Argument that Medicare cannot deny a claim based on an allegation of insufficient documentation unless it reviews the entire medical record.
- On April 22nd, CMS hosted an Open Door Forum on a “suggested” Home Health Electronic Clinical Template. The purpose of the electronic template is to create a set of structured clinical elements that can be incorporated by vendors into their systems and will assist physicians when documenting the Home Health (HH) face-to-face encounter for Medicare purposes. CMS will be hosting additional Open Door Forum calls in 2014 to give interested parties a chance to provide feedback on the template. Additional information on this initiative can be found here.
- Medicare Home Health Part A Contractors are scheduling many webinars on the face-to-face encounter requirements and are encouraging providers to attend.
- Last, a study released by the Department of Health and Human Services Office of the Inspector General in April, 2014 reported 32% of home health claims requiring face-to-face encounters did not meet Medicare requirements, resulting in 2 billion dollars of payments that should not have been made. As a result of this study, the OIG offered the following recommendations which were agreed to by CMS:
- Consider requiring a standardized form to ensure that physicians include all elements required for the face-to-face documentation
- Develop a specific strategy to communicate directly with physicians about the face-to-face requirement
- Develop other oversight mechanisms for the face-to-face requirement
Home health agencies have been citing for years that they are being penalized for physician non-compliance relating to the face-to-face encounter which is a requirement for home health coverage and reimbursement. It appears the home health industry is finally being heard and the recent developments are showing a shift by CMS toward the source, the physician, to correct non-compliance issues relating to the face-to face encounter.