Congress Must Hear from You on Face to Face Legislation
July 12, 2017 03:11 PM
Rep. Earl Blumenauer (D-OR) and Kenny Marchant (R-TX) introduced the Home Health Documentation and Program Improvement Act – better known to the home health community as the face to face/physician documentation certification legislation – in late May of this year. The long-awaited bill would improve the current burdensome regulation regarding physician documentation for Medicare home health services.
A provision of the Patient Protection and Affordable Care Act requires a patient to have a face-to-face encounter with a physician to certify the need for home health care. The implementation of this provision by CMS involves unnecessary and time-consuming paperwork and other requirements that have caused not only considerable confusion among doctors and home health agencies, but, even worse, limited access to care and posed a high risk for denying overage to Medicare beneficiaries who are homebound and in need of skilled nursing care.
The CMS interpretation of this rule led to an ill-defined physician narrative demonstrating the patients need for home care services. Frustration and confusion ensued ultimately resulting in claims being improperly denied that should have otherwise been approved. These claims were deemed “insufficient” by CMS with no further explanation. There are an estimated 25,000 improperly denied claims that have been appealed and are now residing in an untenable backlog. As a result, CMS removed the physician narrative requirement in 2015.
Unfortunately, the current policy put in place by CMS has not been an improvement. Claim status is now solely dependent on the physician encounter documentation. This leaves out the home health agency’s documented comprehensive patient assessment. Claim reviewers are seeing just a piece of the patient’s full record. This clearly does not paint an accurate picture, and predictably, leads to many improper claim denials.
The legislation will remedy this policy’s shortcomings by directing CMS to consider the entire patient record, including the home health agency’s record, when determining benefit eligibility. The bill would also grant CMS the authority to settle improperly denied claims relating to the face to face requirement that currently reside in an appeals backlog.
We Can Fix This
The face to face requirement has been a persistent headache since its inception eight years ago and its evolution over the years has made pinpointing a permanent solution and building congressional support very challenging. However, NAHC believes we have the right solution in the Home Health Documentation and Program Improvement Act and are putting all efforts behind it.
In the House there are currently only 16 supporters for the bill and while that number seems low, it is to be expected. This is a new piece of legislation – it has not been introduced in any previous Congress -- meaning Members of Congress and their staffs are unfamiliar with it and need to learn more before they can put their support behind it. Furthermore, while the bill is a simple fix, it is still a bit technical and not easily understood by laymen.
This is where your help is needed.
NAHC has communicated with members and staffers about this issue and we will continue to do so. However, it makes a bigger impact when members hear from their own constituents. Please reach out to your Representatives and ask for their support on H.R. 2663, the Home Health Documentation and Program Improvement Act. You can send this message to members of Congress in just moments at the NAHC Legislative Action Center.
NAHC will notify members of a Senate bill as soon as it is introduced and keep readers up to date as the legislation builds support in Congress.
A NAHC fact sheet with additional information and talking points can be found here.