Home Health & Hospice Week

Don't get so caught up in the operational and billing details of the new therapy and face-toface rules that you risk your compliance record.

Many home health agencies are still grappling with the burdensome F2F and therapy reassessment rules that went into effect April 1. "Agencies have gotten caught up in trying to get physicians on board," observes attorney Robert Markette Jr. with Gilliland & Markette in Indianapolis. "The number-one complaint I am hearing is that the agencies can't get the physicians to do the necessary paperwork."

That's been the experience of Holy Name Home Care & Hospice in Teaneck, N.J., reports Mary Ann Quirk, the agency's clerical and billing liaison. Physicians just send the 485 paperwork back with the F2F requirements ignored, Quirk tells Eli.

Bright spot: The agency's parent hospital will begin requiring F2F paperwork, when relevant, as part of its discharge process this month, Quirk says. But that won't help with referrals that come from outside the hospital, she notes.

It's problems like these that are distracting home care providers from their compliance responsibilities, cautions attorney Marie Berliner with Lambeth & Berliner in Austin, Texas. Look at the big compliance picture, Berliner urges.

"The primary purpose of those requirements is to establish the patient's initial or continuing eligibility for home health benefits, to ensure proper clinical oversight and regular physician involvement.

Ultimately, the goal is to eliminate overutilization of services or abusive practices resulting from a lack of proper oversight or involvement," Berliner says.

"Agencies should definitely take a broader view of these requirements," advises Washington, D.C.-based health care attorney Elizabeth Hogue.

To make sure you're not neglecting your compliance-related duties when it comes to the new F2F and therapy requirements, consider these steps:

1. Update compliance plans. Revising your plan to reflect the new rules should be the minimum you do on the compliance front, Hogue suggests. The HHS Office of Inspector General soon will be requiring these now-voluntary plans (see related story, p. 156), and they can help you head off compliance problems and defend against fraud and abuse allegations.

2. Target hot spots. Your policies and procedures, and corresponding compliance plan updates, can focus on areas likely to give you trouble.

For example: HHAs are being sorely tempted to give physicians prohibited assistance in completing the F2F encounter documentation, Markette relates. "The staff feels pressured, because a number of physicians appear to be rather hostile to the face-to-face requirements," he says. "Another reason agencies are tempted is that they see theircompetitors cutting these corners."

"Agency compliance officers need to make sure their staff is not 'assisting' the physician in preparing face-to-face documentation," Markette stresses.

Another example: HHAs meaning to be kind can be getting themselves in hot water instead. "Some agencies continue to provide services free of charge, if face-to-face requirements are not met within 30 days of admission," Hogue says. "The provision of free services is, of course, prohibited by the OIG, if the value of the free services exceeds $10 at a time or $50 in a calendar year."

3. Monitor adherence to the new policies. Your compliance program should already use auditing and monitoring for homebound status and medical necessity, Markette says. "Now, agencies can audit for face-to-face requirements" as well, he counsels. "They can look at whether the documentation is present and whether it meets the requirements of the rule."

The new therapy requirements require new levels of monitoring, Markette believes. "Given the ongoing, intense scrutiny of therapy in home health, agencies should routinely be auditing charts for patients that reach the 13th and 19th visit thresholds to ensure the require visits are occurring," Markette recommends. "Also, given the skepticism OIG has for this level of therapy in home health, I would scrutinize these charts for medical necessity, etc. This should be easier to evaluate, with the objective standards requirements."

Plus: "Monitor billing and claims practices closely to make sure they are adhering to the new rules, and to catch and correct any errors early," Berliner adds. Isolated billing problems are just mistakes, but a pattern of non-adherence with billing could be "a true compliance issue," she notes.

4. Keep up training. You've likely provided training to orient staff to the new F2F and therapy requirements. But now may be the time to go back over the new rules with an eye toward compliance issues.

Don't be afraid to review the basics of the new rules. "Ensure that staff are properly trained in the clinical documentation, signature, and date requirements for the face-to-face encounters and therapy visits," Berliner suggests.

If you ignore the compliance implications of the new F2F and therapy requirements, it will be more than just your reimbursement that suffers. "If an agency is not fulfilling the new requirements, it could risk additional scrutiny of claims, trigger more intensive review of claims or invite an inquiry or investigation by one of the agencies charged with identifying overpayments or engaging in fraud prevention," Berliner warns. "These can be very costly to defend, even if the agency has not done anything unscrupulous."