NAHC Files Brief in F2F Lawsuit; Court Hearing on August 6
The National Association for Home Care & Hospice (NAHC) filed its closing brief in the lawsuit challenging the Medicare rule that required physicians to compose a narrative following the patient face-to-face encounter to explain why the individual met the homebound and skilled care need elements of the Medicare home health services benefit. The now-rescinded narrative requirement triggered tens of thousands of claim denials based on Medicare contractors claiming that the narrative statements were insufficient to support the physician certification that the patient was homebound and in need of skilled care.
Within weeks of NAHC’s lawsuit filing, the Centers for Medicare and Medicaid Services (CMS) dropped the narrative requirement from its rule. However, home health agencies nationwide were left with significant claim denials and financial losses stemming from the inconsistent and irrational administration of an unmanageable documentation standard. NAHC continues to litigate the validity of the narrative requirement to address an estimated $150-200 million in claim denials along with the risk that claims prior to the 2015 rescission of the rule could still be audited.
In its brief, NAHC argues that the plain language of the Affordable Care Act provision requiring a physician face-to-face encounter prohibits CMS from imposing the narrative requirement. In the alternative, the NAHC brief argues that the narrative requirement is an arbitrary and capricious rule in that it does not have a rational basis generally or in the context of the Medicare program as a whole. CMS has insisted throughout the litigation that it has the discretionary authority to require a physician narrative and that its implementation of such was reasonable.
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