Home Health & Hospice Week

Burdensome face-to-face requirement is keeping patients from entering home care.

The feds got at least one thing right in their face-to-face revisions contained in the 2015 home health prospective payment system proposed rule.

Reminder: In the rule, the Centers for Medicare & Medicaid Services announced plans to end the controversial physician narrative portion of the F2F requirement. “In an effort to simplify the face-to-face encounter regulations, reduce burden for HHAs and physicians, and to mitigate instances where physicians and HHAs unintentionally fail to comply with certification requirements, we propose that … (t)he narrative requirement … would be eliminated,” CMS said in the proposed rule published in the July 7 Federal Register (see Eli’s HCW, Vol. 23, No. 24).

“The certifying physician would still be required to certify that a face-to-face patient encounter, which is related to the primary reason the patient requires home health services, occurred no more than 90 days prior to the home health start of care date or within 30 days of the start of the home health care and was performed by a physician or allowed non-physician … and to document the date of the encounter as part of the certification of eligibility,” CMS said in the rule.

But in place of the F2F narrative, CMS proposed this new requirement: “In determining whether the patient is or was eligible to receive services under the Medicare home health benefit at the start of care, we would review only the medical record for the patient from the certifying physician or the acute/post-acute care facility (if the patient in that setting was directly admitted to home health) used to support the physician’s certification of patient eligibility,” CMS said in the rule. “If the patient’s medical record, used by the physician in certifying eligibility, was not sufficient to demonstrate that the patient was eligible to receive services under the Medicare home health benefit, payment would not be rendered for home health services provided.”

Docs Flub, Begrudge F2F

HHAs who commented on the rule generally were positive about nixing the narrative. “I wholeheartedly support the elimination of the narrative requirement in the F2F rule,” says a representative of Genesis VNA in Iowa in her comment letter. The comment period on the proposed rule closed earlier this month.

“I am glad to see the elimination of the physician narrative portion of this requirement and commend CMS for hearing the concerns about this very arduous task,” agrees Mohamed Abdelli from Florida in one of the 350-plus letters CMS received on the regulation.

“The narrative requirement is redundant and unnecessary, as medical records should establish medical necessity and homebound status,” so its elimination is good, says 280-location chain Maxim Healthcare Services Inc. based in Maryland.

The narrative has been a nightmare for HHAs, many commenters emphasize. “On a daily basis physicians provide inappropriate, incomplete, or inadequate response” to F2F inquiries, says Horizon Home Care & Hospice in Wisconsin in its comment letter. “In fact, it is rare to receive a face-to-face document that is acceptable.”

“Physicians are angry, sending notes back on F2Fs such as ‘Isn’t it obvious, I am not writing any more information, Have CMS come to our hospital and speak to our doctors, What more do you want,’ etc.,” fumes Victoria Testa in Pennsylvania in her comment letter.

Access issues: “Some physicians are sending patients home at the end of their hospital stays without home health services just so that they do not need to complete the F2F with all of the required information,” Testa says. “Several patients that were being followed in the hospital by our Intake staff have had the home health orders cancelled at the time the F2F was required on discharge. At least one of these patients ended up back in the hospital. That must have cost CMS additional dollars compared to home health services which bridge the gap allowing patients to be discharged sooner and reduces rehospitalizations.”

“Our agency is losing referrals every day, as physicians view this requirement as being too burdensome,” says Partners in Home Care in Mon-tana in its comment letter. “Physicians will refer to outpatient services rather than home health, even when patients would qualify for skilled home health services.”

If CMS does follow through on its proposal for narrative elimination, Abdelli urges the agency to “reopen past claims that were denied due to the narrative in order to reevaluate the claim under this new principle and see if it would qualify for payment,” he says in his letter.  “I would also ask that CMS halt all current audits based on the narrative,” he says.

Stay tuned: The hundreds of parties that commented on the rule, as well as the thousands of HHAs across the nation, will see whether CMS has heeded agencies’ advice and recommendation when the PPS final rule comes out. CMS usually issues the rule in early November. 

Note: To peruse the 354 comments on the proposed rule, go to www.regulations.gov/#!docket Detail;D=CMS-2014-0090, scroll down to the “Comments” section and click on “View All.” Or email editor Rebecca Johnson at rebeccaj@eliresearch. com for a free link to the comment section — include “2015 PPS rule comments” in the subject line.