Home Health & Hospice Week

Agencies are between a rock and a hard spot, and that rock is poised to crush them.

Will first-hand accounts of the extreme difficulties surrounding the face-to-face physician encounter documentation requirements help sway CMS officials? Hundreds of commenters on the PPS proposed rule hope so and have offered up their tales of woe over the burdensome regulation.

Personal, agency-specific details are the most compelling information when it comes to influencing the policy-makers at the Centers for Medicare & Medicaid Services and other federal agencies, industry veterans advise.

Read excerpts from one such missive from Rita Pasquariello in North Carolina:

“I am sitting at my desk where I have just opened 2 Medicare redetermination decisions which were found to be unfavorable to my agency. The auditor states that the patients met homebound eligibility and also medical necessity eligibility to qualify for home physical therapy… . We were denied payment solely on the basis of the auditor finding the physician’s ‘narrative’ on the face-to-face form insufficient. The physician bears no financial loss in this situation and the physician made sure that he ordered what he felt was appropriate for his patient given his diagnosis and identified needs. There was a face-to-face encounter performed and the form was signed and dated by the physician as required in the ACA. We provided services appropriate to the patient’s needs and were denied because the physician did not write the correct narrative statements on the form. …

“If the intent of the face-to-face requirement in the rules is to close home health agencies, limit health care access to Medicare recipients, and frustrate care providers/physicians, then it is a huge success. If the intent of the face-to-face requirement is to decrease/prevent fraud and abuse, this will fail miserably. The agencies who commit fraud will simply complete the forms so that they are acceptable to the auditors and completely by-pass physician involvement.

“I have been in the home care industry for 30 years. I have never encountered a regulatory requirement that I have no ability to enforce. I cannot write the words for the physician, I cannot give him a check box, and I cannot tell him how to complete the form. What incentive does he have since he bears no financial loss and his patient is cared for? I am married to a physician with 25 years of primary care experience. His understanding of the intent of the rule was to ensure that the physician had contact with these patients prior to or within 30 days of initiating care since he will be providing oversight and signing orders. I believe that CMS has overstepped the ACA rule related to physician face-to-face encounter. This will result in closing of agencies which will lead to access issues for patients and eventually a breakdown in the quality of care they receive.

“Please, please re-evaluate and reconsider this ruling and the initial intent.”