Home Health & Hospice Week

If Medicare's final rule guidance on the new face to face encounter (FFE) has left you confused, you aren't alone.

The Centers for Medicare & Medicaid Services spent much of the Dec. 1 Open Door Forum clearing up confusion about the FFE requirement and the guidance it offered in the 2011 prospective payment system final rule.

The bottom line: Starting Jan. 1, the physician who certifies the patient for home care must also perform the face to face encounter (FFE) and document it, CMS's Randy Throndset emphasized in the forum.

Home health agencies must consider the FFE documentation part of the certification, even if the FFE portion is a separate addendum, Throndset explained. They "must travel together and can't be dealt with separately."

On the other hand: A different physician can sign the patient's plan of care, CMS's Lori Anderson pointed out in the forum. For example, a hospital physician may perform the FFE and complete the required documentation and the certification, Anderson said. Then the patient's physician in the community may pick up the patient at discharge and sign the plan of care that was initiated under the hospitalist's orders.

You just can't have two different physicians doing the certification and the FFE, the CMS officials emphasized to participants.

Not just hospitalists: It's not only physicians in hospitals that qualify under this provision, explains the National Association for Home Care & Hospice. Any facility-based physician can make the referral, perform the FFE and documentation and certify the patient, the trade group has confirmed with CMS. That includes physicians from rehab or skilled nursing facilities, NAHC says.

You're On The Hook

CMS also reiterated that HHAs are not allowed to use home health advance beneficiary notices (HH ABNs) to hold patients liable for payment if the FFE doesn't occur. "The HH ABN is not approved to transfer liability to the beneficiary when technical requirements for payment, such as the face to face, are not met," Throndset said.

The FFE mandate is part of the certification requirement overall and "is thus the responsibility of the HHA," Throndset explained. The situation is similar to trying to bill patients if the agency doesn't get a physician signature on the plan of care.

Keep watching: CMS says it plans to work "consideration" for "minor timing delays" into its contractor instructions about the FFE requirement. That could give agencies some reimbursement relief if they don't hit the FFE deadline.

CMS also emphasized that physicians can't just sign off on "canned language" from the HHA to furnish the FFE documentation. "We expect the physicians to draft the documentation language," Throndset noted.

If CMS allowed docs to just fill in the blanks, "we wouldn't be achieving the level of physician involvement that was intended with this provision of the law," he added.

However: It does seem OK for agencies to provide a general template to docs for FFE documentation, NAHC indicates. CMS told the trade group it would be acceptable to label the section of the plan of care or addendum where the physician's documentation should be placed, title it, and include subheadings such as: Date of Encounter, Medical Condition for Encounter, Services Needed, Clinical Findings, Homebound Status, Physician Signature, and Date, according to NAHC.

Such a template is "fine ... as long as the info/clinical findings and how the findings support eligibility are documented by the physician, in his/her own words," CMS reportedly told NAHC.

But using too much guidance for physicians, such as "lead-in phrases," is off limits, Throndset said in the forum.

Tool: NAHC offers a documentation model for free on its website at www.nahc.org/regulatory/home.html. The trade group also offers nine other FFE-related documents free of charge, including notices to physicians, NAHC's Mary St. Pierre noted in the forum.

Meanwhile, don't be surprised if you have to do the heavy lifting on educating physicians about the new requirement. Your referring physicians aren't likely to have heard from Medicare about the FFE requirement. Aside from some mentions in physician open door forums, CMS hasn't issued any education on the matter yet, Anderson said.