Home Health & Hospice Week

Industry seeks CMS clarification on face-to-face-related instruction.

The extension and expansion of the Review Choice Demonstration may bring a troublesome new policy to your doorstep — unless home health agencies and their advocates can rein it in.

On May 14, three days before announcing the RCD extension (see story, p. 138), HHH Medicare Administrative Contractor announced that “beginning May 20, 2024, home health agencies must submit a hand-off from any original certifying provider to a subsequent provider.”

The article posted to Palmetto’s website and sent to providers, titled “Home Health Review Choice Demonstration Certifying Provider Change,” elaborates that “if one physician or nonphysician practitioner (NPP) performs the original certification, and a different physician or NPP is recertifying, Medicare needs to see the hand-off between practitioners.”

Palmetto specifies that “if multiple physician/NPP changes have occurred, Medicare needs documentation for each hand-off ” and that “there is no designated format or form that must be used to show the hand-off.” The MAC explains that “documentation can include, but is not limited to, progress notes, orders to change primary physician or NPP, or anything that shows the change(s) in certifying provider.”

Do: “If ‘Dr. A’ signed the initial certification and ‘Dr. B’ signed the recertification, there should be documentation signed by ‘Dr. A’ that the patient was handed off to ‘Dr. B.’ This is acceptable,” Palmetto offers.

Don’t: “If multiple physician/NPP changes have occurred, Medicare needs documentation for each hand-off,” Palmetto mandates. “In this example, let’s assume ‘Dr. A’ signed the initial certification, and ‘Dr. D’ signed the fourth recertification. There is documentation of a hand-off to from ‘Dr. A’ to ‘Dr. B’ present, but it is signed by ‘Dr. C.’ This is unacceptable as there must be a hand-off of care between each physician or NPP in the chain,” the MAC instructs.

This brand new guidance has caught HHAs and their representatives off guard, to say the least.

The new policy “is a requirement totally ungrounded in any applicable rule or regulation — other than the very indirect need to communicate changes in the plan of care found in the CoPs (42 CFR 484.60),” protests consultant Joe Osentoski with Gateway Home Health Coding & Consulting in Sterling Heights, Mich. “It provides a way to deny a claim if it is not found (this ‘hand-off ’) in the record,” Osentoski warns.

“This is a new requirement by Palmetto,” concurs consultant J’non Griffin with SimiTree based in Hamden, Conn. “This is not anywhere in the regulations — that there has to be a ‘hand-off ’ after the initial hand-off from the practitioner who provided the [face-to-face] to the certifying physician or practitioner,” Griffin says.

“Seriously, where did this come from?” asks one industry veteran.

“It is a significant change in policy,” says Mary Carr with the National Association for Home Care & Hospice. NAHC is seeking clarification from CMS on the matter, Carr confirms.

Several industry experts also plan to bring up the issue with the MAC at Palmetto GBA’s 16-State Coalition meeting on June 3, they say.

Keep in mind: “Good practice says that communication and identification of change in certifying allowed practitioner is a good thing,” Osentoski allows. “But nothing I’ve found requires it,” he stresses.

Watch out: “Easy, non-fixable denials will be issued as agencies will fail to comply,” Osentoski predicts. While the scenario may not happen that often, “it can easily be picked up in the billing that can focus ADR activity on it, as well as pre-claim review snagging it,” he warns.

And HHAs shouldn’t assume they are protected from the new policy if they’re not in an RCD state. It may expand outside of RCD, or come along with RCD when it expands, observers caution.

Note: The notice is at www.palmettogba.com/palmetto/jmhhh.nsf/DID/4184J8QCJK.