Home Health & Hospice Week

But stick with your appeals.

If you think you can duck your head in the sand and wait for rescue on the face-to-face requirement, think again.

A federal court has ruled against the industry in the F2F lawsuit filed by the National Association for Home Care & Hospice, the trade group tells its members. In a Nov. 3 decision, the court rejected NAHC’s claim that a narrative requirement in the F2F physician encounter rule is invalid, NAHC says.

However, the F2F rule should not allow “a Medicare claim reviewer to second-guess the medical judgment of a patient’s physician,” the opinion says. “If the rule authorized a reviewer to deny a claim … simply because she disagreed with the physician’s clinical findings or the physician’s reasoning … that would go far beyond what the statute allows.”

NAHC hopes that statement will help agencies win claims appeals for denials based on insufficient narratives, it says.