Homecare Advocate Testifies Before House Energy & Commerce Subcommittee on Health: Hearing Held to Discuss Legislation to Reform the Home Health Face-to-Face Physician Documentation Requirement
October 1, 2015 04:41 PM
The House Energy & Commerce Subcommittee on Health held a hearing on Thursday, October 1, on three bills to improve the Medicare program, including the draft legislation, the Home Health Documentation and Program Improvement Act of 2015, introduced by Congressman Greg Walden (R-OR). The legislation would reform the Centers for Medicare & Medicaid Services (CMS) home health face-to-face encounter documentation requirement by eliminating unnecessary paperwork, refocusing the requirement on patients who may not have a strong relationship with their physicians, and preventing unwarranted claim denials for patients where the overall record demonstrates that the patient meets Medicare coverage standards. The National Association for Home Care & Hospice (NAHC) submitted formal testimony at the hearing in support of Congressman Walden’s proposed legislation.
“NAHC strongly supports the proposed reforms as needed to address the unmanageable rules that have been instituted by the Centers for Medicare and Medicaid Services requiring extensive and unnecessary paperwork from physicians,” NAHC stated in its testimony. “The bill would specifically address the two most important reforms that are needed: the documentation requirements and the unnecessary application of the requirements to patients admitted to home health services following an inpatient stay where multiple physician/patient encounters occur… In addition, it would address the past claim denials that were issued through application of a documentation standard that no one could understand, a standard later abandoned by CMS. NAHC supports each of these necessary reforms.”
Among the hearing witness was Sarah Myers, Executive Director of the Oregon Association for Home Care, who testified about the importance of Congressman Walden’s legislation. “One of the greatest burdens we face today is the implementation of the face-to-face requirement,” she stated. “Fortunately, there is a solution: Congressman Walden is authoring legislation that would establish a simple approach to documenting physicians’ face-to-face encounter with their patients. In place of confusing requirements, this reform would ensure the policy is clearly and logically upheld through physician recording of the date of the encounter and use of a standardized form to identify the clinical condition for which home health is needed.”
In his opening statement, Congressman Walden said that home health in general is “less expensive, more convenient, just as effective as care in a skilled nursing facility,” and that “receiving care at home gives seniors more control over their health care and provides a sense of comfort and familiarity for the patient and for their loved ones.” However, he stated, the “current documentation requirements, associated with the so-called face-to-face requirement, have placed significant pressures on the home health care community and the people they serve.” Congressman Walden further explained the importance of the proposed legislation to reform the requirement. “We have a situation in which a complicated regulatory process simply needs to be streamlined and standardized, and that’s what this legislation would do,” Congressman Walden said. “Mr. Chairman, this isn’t just about a backlog of appeals and red tape; it’s about improving access to, and quality care of, our seniors.”
Support for Congressman Walden’s proposal came from a number of subcommittee members. Congresswoman Susan W. Brooks (R-IN) stated that the face-to-face documentation requirements created by CMS are “complicated and confusing,” leading to “crushing burdens” for home health agencies, creating a “care crisis.” Congressman Ben Ray Lujan (D-NM) was concerned about the impact of the face-to-face documentation requirements on access to care in rural areas of New Mexico where physicians are scarce. Congressman Michael Burgess (R-TX), a physician, recognized the need to combat fraud and abuse but expressed that a Medicare contractor’s denial of a claim because the physician did not do enough paperwork to satisfy the contractor is not what is needed.
In its submitted testimony, NAHC explained that “the administration of the face-to-face encounter requirement has led to unintended confusion, burdensome paperwork for physicians, increased costs for home health agencies without any material improvement in program integrity, and an endless paper-chase.” NAHC also stated the requirement has been “ineffective” in targeting any waste or abuse in the Medicare program. “An abusive provider has an easier time showing compliance with the requirements through falsified documentation than a home health agency that wants to be fully compliant,” NAHC stated. “Notably, the face-to-face encounter requirements often lead to Medicare rejecting claims for patients who are truly in need of the physician-prescribed skilled care and who meet the benefit’s ‘homebound’ requirement because of a subjective standard of what face-to-face encounter documentation is ‘sufficient’ as that limited documentation supersedes the complete patient record.”
The bill would address these problems through the following reforms: 1. Limit the physician documentation requirement to demonstrating that a timely encounter occurred, consistent with the original intent; and 2. Narrow the circumstances where a face-to-face encounter is required by excluding patients transferred from a hospital or SNF where physician encounters are virtually guaranteed. The bill would also address the thousands of past claim denials by requiring CMS to either reach a settlement with affected home health agencies or reopen and pay those claims denied related to the physician narrative.
While NAHC has advocated that Congress repeal the face-to-face physician encounter provision, NAHC stated that “the reforms proposed in the legislation are a significant improvement over the current requirements and present a manageable middle-ground that maintains the core requirement of a physician face-to-face encounter with the patient while addressing the daunting paperwork burdens that lead to unnecessary problems for qualified Medicare beneficiaries, physicians, home health agencies, and the Medicare program.”
In addition to the reforms contained in the bill, NAHC has stated that full-scale reform should also: provide an exception in areas where physicians are scarce; permit a waiver in a case-specific situation where a face-to-face encounter is not feasible; permit face-to-face encounters by way of an expanded telehealth definition as the standard in the current law is useless as a patient must leave her home to have a telehealth visit with a physician.
In the Senate, similar bipartisan legislation has been introduced by Senators Robert Menendez (D-NJ) and Pat Roberts (R-KS).
NAHC will continue to work with lawmakers in support of advancing the legislation to reform the face-to-face documentation requirement. 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. A decision on its lawsuit challenging the validity of the physician narrative requirement is likely any day from the federal court in Washington. You can read more about NAHC’s lawsuit here.