Home Health & Hospice Week

Docs threaten to cut off home care referrals in face of burdensome new requirements.

The new face-to-face physician encounter requirements may be a nightmare home health agencies can’t wake up from, but it’s a nightmare you’ll have to face head on if you want to preserve your Medicare reimbursement.

Background: Starting April 1, the Centers for Medicare & Medicaid Services will begin enforcement of the face-to-face encounter requirement. Under the requirement finalized in the 2011 PPS final rule published in the Nov. 17, 2010 Federal Register, certifying physicians must see the home care patient 90 days prior to start of care or 30 days after care begins for the reason the patient is requiring home care. And the certifying physician must document the encounter as part of the certification itself or as a signed addendum to it. The documentation must include the date when the en-counter occurred and a brief narrative that describes how the clinical findings of the encounter support the patient’s homebound status and need for skilled services. HHAs and hospices can’t bill for the patients if the F2F encounter isn’t performed.

Home health agencies and hospices are very frustrated with trying to implement the F2F process, reports consultant M. Aaron Little with BKD in Springfield, Mo. "I’ve yet to hear from any clients that feel like they have successfully been able to implement the requirement to a satisfactory level and/or get the buy-in of the physicians," Little says.

These difficulties persist even after agencies have done months of preparation and intensive physician education, says consultant Pam War-mack with Clinic Connections in Ruston, La.

Many providers are seeing physicians auth-orizing outpatient therapies instead of home care, says consultant Tom Boyd with Boyd & Nicholas in Rohnert Park, Calif. Switching from home care to outpatient therapy creates many problems for beneficiaries, Boyd maintains -- a lack of nursing services, the issue of transportation, a copay, and the cap on outpatient therapy.

"A large number of physicians initially informed agencies that they would simply discontinue referring to home care if they had to document on yet another form," Warmack adds. However, "many of these physicians have failed to carry through with that threat as of this time," she concedes. "But April 1 may be another story."

Providers in rural areas are seeing particular problems with F2F, Boyd tells Eli.

Ready Or Not, F2F Is Coming

Industry representatives including the Na-tional Association for Home Care & Hospice are working to try to secure another postponement of the F2F requirement. In a recent letter to CMS Admini-strator Donald Berwick, Reps. Ben Chandler (D-Ky.) and Tim Holden (D-Pa.) ask the agency to delay the F2F enforcement date further.

And the congressmen take CMS to task for carrying the reg "beyond the original intent" of the health care reform law, the letter says, according to NAHC. CMS’s requirement for an attestation statement that includes the date of the F2F encounter, the medical condition, the clinical findings, reason for being homebound, and the skilled services identified is an additional paperwork requirement not authorized by the law, the lawmakers say. Instead, CMS should consider just adding a field to the existing 485 for documenting the F2F, the letter proposes.

Plus: A coalition of 12 provider groups in-cluding NAHC, the Visiting Nurse Associations of America, the American Medical Association, the American Academy of Home Care Physicians, and other physician groups sent Berwick a March 12 letter asking for a postponement of F2F enforcement until at least July 1. The coalition also asks CMS to significantly streamline physicians’ documentation requirements for F2F.

Ready Or Not, F2F Is Coming

But don’t let those efforts lull you into a false sense of comfort. While many home care providers have been hard at work on F2F, others have been ignoring the requirement in hopes that it will just go away. "We strongly believe that cancellation will not happen and everyone needs to prepare for F2F," Boyd stresses.

The F2F requirement is "going to go into effect at some point whether we like it or not," be-lieves consultant Lynda Laff with Laff Associates in Hilton Head Island, S.C.

Unfortunately, the F2F requirement is likely to lead to a decrease in referrals to home care, lower home care utilization, and access problems for beneficiaries (especially in underserved areas), Boyd predicts. And costs will increase for Medicare as home care-eligible patients are shifted to institutions like nursing homes and hospitals or into more physician visits.

Ironic: "Those providers that pay physicians for referrals will be least affected" by F2F requirements, Boyd says. "Those are the ones CMS should go after."

Note: You can sign up for M. Aaron Little’s Eli-sponsored F2F audioconference, "Warning Home Health & Hospice Providers: Face-to-Face Encounter Requirements Are In Effect," which takes place Wed. March 23. Go to http://www.audioeducator.com/conference-conferencehome-health-face-to-face-encounter-230311 or call 1-866-458-2965.