Senators Seek to Reform Home Health Face-to-Face Physician Documentation Requirement
July 23, 2015 09:36 AM
Senators Robert Menendez (D-NJ) and Pat Roberts (R-KS) are working on legislation to reform the home health face-to-face physician encounter documentation requirement. The Senators demonstrated their commitment to addressing the issue in June by introducing a bill (S. 1650), and they are continuing their efforts to improve the bill in order to ensure it resolves serious concerns with the existing face-to-face requirement and its impact on patient care.
Both Senators have expressed the need for legislation in order to reform the existing requirement. “The existing home health face-to-face requirement is simple in theory, but has proven unworkable in practice,” said Senator Menendez in a statement regarding his efforts to reform the face-to-face requirement.
“I’ve been concerned the face-to-face encounter requirement would be particularly difficult for our most vulnerable beneficiaries, especially those in rural areas, and could limit access to care,” said Senator Roberts.
The current face-to-face encounter requirement to certify eligibility for home health services has resulted in substantial increases in home health claim denials and a backlog of appeals. Under a provision of the Affordable Care Act, a home health provider cannot bill Medicare for services to a home health patient unless the certifying physician has a face‐to‐face encounter with the beneficiary 90 days prior to the start of home health or 30 days after the start of home health. As part of this certification, CMS required physicians to document several detailed clinical findings in a narrative in order to support the need for home health services. CMS has since dropped the narrative requirement (see previous NAHC Report article here) but replaced it with a physician documentation requirement that can be equally problematic.
As a result of the previous narrative requirement, Medicare has denied payment for thousands of home health services. Agencies and certifying physicians are now struggling to comply with the new physician documentation requirement. According to a nationwide home health provider survey, 52% of face‐to‐face claim denials resulted mainly from Medicare determining that the physician documentation was insufficient, even though medically necessary care was provided. The federal Office of the Inspector General (OIG) has recommended a more uniform method for physicians to document face‐to‐face encounters, based on the fact that physicians are experiencing difficulty complying with the cumbersome requirements. Seventy‐five bipartisan members of Congress stated that the “complicated, confusing and overlapping documentation requirements … exceed the intent of the law passed by Congress.”
In June, Senators Menendez and Roberts introduced the Home Health Documentation and Program Improvement Act of 2015 (S. 1650) in an attempt to address the problem by reformingthe documentation requirement. The legislation would require CMS to develop a standardized form for collecting evidence of a beneficiary’s eligibility for home health services. It allows ahome health agency to complete the form that is then reviewed and signed by the referring physician. The bill exempts home health agencies from collecting documentation for beneficiaries who have been discharged from a hospital or skilled nursing facility within 14 days prior to the initiation of home health services. It also seeks relief from past claim denials.
Although the legislation allows the home health agency to fill out the form, it requires that a statement justifying eligibility for home health services must be included in the form. This sounds similar to the previous narrative requirement that CMS abandoned. The home health agency would be allowed to compose the statement for the physician, but NAHC is concerned that claims could still be denied based on a subjective determination that the statement is insufficient even when a review of the whole record would establish eligibility. This could result in technical denials of valid claims.
NAHC is working with the sponsors of the legislation to delete the bill’s requirement of a statement and simply require that the physician document that the face-to-face encounter occurred. Stay tuned to NAHC Report for more developments in the ongoing campaign to obtain relief from the F2F documentation requirements.
In addition to seeking a legislative remedy, NAHC continues its legal challenge to the claim denials resulting from the Medicare home health services physician face-to-face narrative requirement. You can read more about NAHC’s lawsuit here.