Home Health & Hospice Week

Watch out: Make sure physician encounters include both audio and visual components.

With the regulatory landscape changing weekly, daily, or even hourly in the face of COVID-19, home care providers are struggling to figure out where they should stand on important requirements — including the face-to-face physician encounter.

Background: After liberalizing telehealth rules for physicians, the Centers for Medicare & Medicare Services confirmed last month that “the face-to-face encounter … can be performed via telehealth,” according to a COVID-19 Frequently Asked Question set last updated April 17.“Under the expansion of telehealth under the 1135 waiver, beneficiaries are able to use telehealth technologies with their doctors and practitioners from home (or other originating site) for the face-to-face encounter to qualify for Medicare home health care” (see Eli’s HCW, Vol. XXIX, No. 11).

CMS then specified in its interim final rule for COVID-19 changes that hospice F2F visits could be performed “via telecommunications technology” also (see Eli’s HCW, Vol. XXIX, No. 12-13).

Questions remain: HHAs are still trying to figure out what counts as a F2F visit.A caller in CMS’s April 14 COVID-19 call for HHAs and hospices asked whether the F2F visits could occur with just voice technology.

A CMS official confirmed in the call that a F2F visit must contain “audiovisual.”

Until Regs Come Out, You Must Assume

Another question about face-to-face visits is whether they can be performed by non-physician practitioners under the CARES Act provision allowing nurse practitioners, clinical nurse specialists, and physician assistants to order home health services, sign the plan of care, and certify/recertify eligibility (see story, p. 118).

If you have decided that CMS allows NPPs to order home health now, you must determine your F2F policy.“CMS could have been clearer that when they say ‘certify and recertify,’ they are including the face-to-face requirement,” critiques attorney Robert Markette Jr. with Hall Render in Indianapolis.It would have been helpful for CMS to say in its COVID-19 HHA flexibilities document that “the NPPs can not only perform a face-to-face encounter, but can certify it as well,” Markette says.

However: “I think that is a pretty safe assumption, because it would be odd to say that the NPPs can certify, but then exclude face-to-face,” Markette judges.“It would be hard for CMS to explain that distinction.”

Note: The four-page flexibilities document for HHAs is at www.cms.gov/files/document/covid-home-health-agencies.pdf.