Home Health & Hospice Week

Will your F2F documentation pass muster?

A federal watchdog's investigation of home health agencies' face-to-face encounter compliance could get ugly fast, depending on how reviewers tackle the subject.

In its newly released Work Plan for 2013, the HHS Office of Inspector General says it will "determine the extent to which home health agencies ... are complying" with the F2F requirement, which mandates an encounter with a qualifying doc or NPP up to 90 days before or 30 days after home care begins. Before the F2F requirement took effect, about 30 percent of home care patients met this standard, the OIG notes.

The OIG's findings may be relatively positive if it focuses only on whether the patient met with the physician or NPP, observers expect. But if the OIG decides to focus on whether docs' F2F documentation complies, it could be a different story.

The OIG's scrutiny of F2F is likely to lead to reimbursement recoupment for non-compliant agencies, warns attorney Robert Markette Jr. with Benesch, Friedlander, Coplan & Aronoff in India-napolis. "Agencies need to be diligently checking that they are meeting the face-to-face requirements," Markette urges.

The OIG Work Plan addresses at least 10 subjects related directly to home care, but it leaves out some compliance issues that concern provider the most, insists Washington, D.C.-based health care attorney Elizabeth Hogue. Agencies are worried about "real abuses" such as "payments to referral sources and violations of patients' rights to freedom of choice," Hogue tells Eli.

Other topics covered in the plan include:

• Criminal hires. Nearly all states prohibit health care providers from hiring aides and other employees with criminal records. The OIG will check whether HHAs are conducting background checks of aides and complying with applicable laws. A similar OIG review of nursing homes found that 92 percent of homes employed at least one staffer with at least one criminal conviction.

Do this: "Providers should be certain their personnel files contain proof of the performance of required background checks, including state and federal criminal history checks," Markette advises. "What is or is not a disqualifying conviction varies, but providers should be certain they have the appropriate documentation of the check."

• PPS. The OIG will examine various as-pects of the prospective payment system in multiple reports, ranging from documentation to eligibility. This is nothing new, Markette notes. "Agencies should be actively reviewing clinical records to ensure they are in compliance with homebound status, intermittent nursing need, medical necessity, etc.," he counsels. "This is an issue that has been raised in numerous OIG work plans over the years and agencies should just plan to audit and monitor these areas routinely as long as they are in the industry."
• Payment reform. Cost report data will be front and center as the OIG analyzes trends in expenses and revenues, with an eye toward PPS payment reform. Don't be surprised to see the OIG conclude that rates should be rebased downward, Markette cautions. "This proposed review specifically notes that Medicare home health expenditures are up significantly," he says. "I think this review ... will result in the determination that overall Medicare reimbursement for home health may be reduced, because agency profits are so high. This conclusion will then drive rebasing."
• OASIS. How accurate is your OASIS pro-cess? The OIG will check for OASIS data submitted in support of a claim, as well as claims where "the billing codes on the claims are inconsistent with OASIS data."
• MACs. Medicare Administrative Con-tractors will have someone looking over their shoulders for a change, as the OIG scrutinizes their claims and anti-fraud activities.
• Surveys. Ditto for surveyors, as the OIG examines timeliness and outcomes of recertification and complaint surveys.
• Medicaid. The OIG will take on a number of Medicaid home care issues, including payment duplication with Medicare, screenings for employees, eligibility, and homebound status.