Home Health & Hospice Week

With the April 1 deadline for the physician face-to-face encounter nearly here, home care providers are getting desperate to get into compliance with the burdensome regulation. Now some information has come from the feds that may help agencies in that effort.

Physicians can merely sign off on the F2F documentation their "support staff" prepares for them, says a new question-and-answer posted by the Centers for Medicare & Medicaid Services on its website. "A physician's own support staff can help the physician draft the face-to-face encounter documentation narrative in a number of ways," CMS says in the Q&A.

The agency lists examples of how that might work. "The support staff can extract the narrative from the physician's own medical record documentation of the encounter," CMS says in Q&A #10482. Or "the support staff can generate the narrative from the physician's electronic medical record software."

Another option: "The certifying physician can dictate the narrative to the physician's support staff," CMS says.

Hospital discharge planners can fulfill this support staff role too, CMS said in a Q&A posted last month (Q&A #10414).

In fact, the definition of support staff is pretty wide. "Physician support staff are those staff who work with or for the physician on a regular basis, and, as part of their job duties regularly perform documentation, take dictation from the physician and/or extract from the physician's medical records to support the physician in a variety of ways," CMS says in a separate Q&A (#10484).

"This allowance by CMS will make it easier for agencies to receive the documentation that they need from physicians," predicts consultant M. Aaron Little with BKD in Springfield, Mo.

Pressure from the docs themselves probably helped bring about this clarification, believes Chicago- based regulatory consultant Rebecca Friedman Zuber. "Clearly this stuff is coming from the [American Medical Association] and probably other physician groups," Zuber tells Eli.

"This is a step in the right direction," says Rohnert Park, Calif.-based consultant Tom Boyd. "But [it] can also increase the likelihood of error or miscommunications." HHAs will have to review documentation carefully for the necessary elements.

And while the clarification is helpful, it won't be a panacea for the problems home care providers are having in securing F2F documentation. "I am still hearing about a lot of frustration and 'acting out' on the part of physicians," Zuber relates.

"Among the reasons doctors resent this is the absence of payment to them for F2F and theincreased responsibility," Boyd says.

Do this: The new Q&A reinforces the importance of targeting F2F education at your referring physicians' support staff, Little stresses. Agencies should "thoroughly educate the support personnel of their key referring physicians so that those personnel can understand exactly what information is needed by the agency to satisfy this new requirement," he urges. "The physicians' support personnel will likely play a very critical role in helping the agency maintain compliance."

Meanwhile, industry representatives continue to work for a postponement of the F2F enforcement deadline. Support from physician and hospital groups may boost the chances of success for a delay.

Optimistic: "The odds favor CMS granting the further extension of suspension of the rule's enforcement," believes William Dombi, vice president for law with the National Association for Home Care & Hospice. In a recent meeting with CMS,an "unprecedented coalition of parties presented a persuasive case for the extension on the merits of doing so," Dombi says in the trade group's member newsletter.

If a delay fails to materialize, the industry will launch a much more high-profile advocacy effort, NAHC says.

CMS recently issued other new Q&As about F2F issues, including:

• An example of what the F2F narrative should look like: "The patient is temporarily homebound secondary to status post total knee replacement and currently walker dependent with painful ambulation. PT is needed to restore the ability to walk without support. Short-term skilled nursing is needed to monitor for signs of decomposition or adverse events from the new COPD medical regimen," CMS gives as an example in Q&A #10480.

• The written instruction that HHAs must use the home health advance beneficiary notice (HHABN) Option 2 when discontinuing services related to the F2F requirements not being met (see Eli's HCW, Vol. XX, No. 10, p. 74).

"HHABN Option 2 must be used if an HHA has initiated home health services and chooses to terminate services for administrative reasons such as lack of a face-to-face encounter," CMS says in Q&A #10481. "If possible, the HHA should provide the notice in advance of the termination date so that the beneficiary has an opportunity to work with the HHA and his/her physician in their complying with this requirement."

Remember: Issuing the ABN doesn't mean you can bill the patient for the services. "HHABN Option 2 is a change of care notice and has no bearing on financial liability," CMS reminds providers.