CMS Issue Plans for Medical Review of the F2F Requirement
May 29, 2015 09:42 AM
The Centers for Medicare & Medicaid Services (CMS) has issued its initial plan for medical review of the home health face-to-face (F2F) encounter requirement. CMS plans to initiate a “Probe and Educate Review” process beginning Oct 1, 2015. These reviews will impact claims with a “from” date beginning August 1, 2015. This strategy is what the National Association for Home Care & Hospice (NAHC) recommended to CMS with the revised F2F encounter requirements that went into effect January 1, 2015.
NAHC recommended that CMS implement a period of test audits prior to issuing claim denials related to the F2F encounter requirement. Although CMS never stated that they would implement such a plan, they seem to be following that recommendation. Hopefully, CMS will ensure adequate education is provided prior to denying any claims related to F2F encounter. The link below is to the CMS web site where additional information regarding the probe will be posted.
Probe and Educate Reviews
CMS will conduct pre-payment reviews of home health claims for episodes beginning on or after August 1, 2015. CMS contractors will conduct these reviews using a Probe and Educate strategy through an end date to be determined. The purpose of this Probe and Educate process is to ensure that HHAs understand the new patient certification requirements. Because home health episodes have a 60-day certification, CMS anticipates the first documentation requests will be sent on or about October 1, 2015.
Probe and Educate Process
CMS plans to provide additional details and information on the Probe and Educate process shortly. Please check back to this website for more information.