Home Health & Hospice Week

Don’t overlook a common reason for claims denials, especially with cash flow so critical under the Patient-Driven Groupings Model.

“The actual Face-to-Face encounter visit must demonstrate that the encounter was related to the primary reason that the patient requires home health services,” stresses HHH Medicare Adminis­trative Contractor CGS. The Medicare Benefit Policy Manual spells out that “the Face-to-Face encounter must be related to the primary reason for homecare,” CGS says in a recent post on its website.

“Medical review examines the Face-to-Face encounter to ensure the clinical documentation corroborates the primary reason for home care,” CGS tells providers. “When reviewing Face-to-Face documentation think … ‘Does the Face-to-Face encounter visit clinical documentation support this?’” the MAC urges.

CGS points to the Centers for Medicare & Medicaid Services’ explanation of this policy in MLN Matters Article SE1426. “The certifying physician’s and/or the acute/post-acute care facility’s medical record for the patient must contain the actual clinical note for the face-to-face encounter visit that demonstrates that the encounter … was related to the primary reason the patient requires home health services,” CMS says in the article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1436.pdf.