New England Senators Send a Letter on Face-to-Face Issue to CMS Administrator Tavenner
November 24, 2014 04:34 PM
Last week, nine senators representing New England states sent a letter to the Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner expressing growing concerns that home care providers in the region are having with CMS’ cumbersome face-to-face requirements.
The letter was signed by both senators from the states of Maine, New Hampshire, Vermont, and Massachusetts, and one of the senators from Connecticut. The letter, originated by Senator Kelly Ayotte (R-NH), crosses ideological and partisan lines with Democrats, Republicans and Independents alike signing the letter on behalf of the home care and hospice community in the Senators’ respective states.
The letter states that:
“Home health agencies in our states are being overwhelmed by a significant increase in medical review activity, with millions of dollars in payment denials related to physician face-to-face (F2F) documentation for medically necessary care to Medicare beneficiaries. Home health agencies in New England inform us that these reviews and payment denials, which they believe in many cases are unjustified, could jeopardize seniors’ access to home health care.
New England home health agencies are critical partners in helping seniors stay in their homes and age with dignity, as well as recover from illness or injury. Often, the home is the most cost-effective care setting, as well as the place where most seniors prefer to receive care… We believe it is also important to ensure that regulations are clear and consistent and that they do not result in reduced access to care for seniors and home health beneficiaries in our states…
In certain instances, during 2014, withheld and denied reimbursements have exceeded the cost of a 2-week payroll for some New England agencies. Home health agencies in New England are confident that when many of these cases are reviewed at the higher appeals level, payment coverage will be granted. However, with the current backlog of Medicare appeals, agencies could wait years to recover reimbursement.”
The letter additionally asks that CMS respond to the concerns raised by taking the following concrete actions:
Explain what additional steps CMS will take to better ensure the clarity of the F2F regulations to prevent any further inconsistent denial of claims across the country;
Describe how [CMS] will ensure that patient care will not be compromised while the appeals of F2F denials are being considered;
Provide [the signatories] with a current list of the outcomes of Medicare home health F2F denials and appeals across the country; and
Consider the feasibility of working with home health agencies to reopen or settle claims related to F2F in a manner that is equally fair to both taxpayers and home health providers. Such considerations could include analysis as to whether an agreement similar to the administrative agreement process recently offered by CMS to hospitals that have a high volume of background claim denials would be appropriate for backlogged home health claims related to F2F.
NAHC Report recently reported on the Medicare backlog that the New England senators addressed in their last bullet point. To read more about the backlog, and NAHC’s proposal to work with CMS to work out an agreement similar to the one work out with hospitals, please click here.
To read the full letter, please click here.