Home Health & Hospice Week

Background: In the 2011 prospective payment system final rule and in subsequent questions and answers, the Centers for Medicare & Medicaid Services has made clear that home health agencies should not use the home health advance beneficiary notice to make patients liable if a valid physician face-to-face encounter fails to occur, which precludes the agency from billing Medicare for the episode (see Eli's HCW, Vol. XIX, No. 41, p. 322).

But now CMS says agencies should use the HHABN to notify patients when home care services will end due to the F2F requirement not being met. However, instead of using Option Box 1, which transfers financial liability to the patient, HHAs should use Option Box 2, which CMS tells agencies to "use when items and/or services will no longer be provided for financial and/or other reasons."

CMS's Evelyn Blaemire gave the clarification in the March 2 Open Door Forum for home care providers. Agencies should note they still can't use the ABN to bill the patient, however. "The HHABN formatted with Option Box 2 has no bearing on financial liability and is a change of care notice only," Blaemire told forum attendees.

Important: In fact, agencies have to use the HHABN when discharging a patient due to F2F reasons, Blaemire said in the forum. In such cases, "the beneficiary must receive written notice of this change of care in the form of an HHABN with Option Box 2," she told providers.

CMS doesn't have this "clarification" in writing yet, CMS's Lori Anderson acknowledged in the call. But a question-and-answer on the issue will be forthcoming, Anderson promised.

Issuing an official Q&A "would be very helpful, because I don't think that that is clear," Rachel Hammond with the Texas Association for Home Care & Hospice said in the forum. "Putting it in writing would be extraordinarily helpful." The National Association for Home Care & Hospice has seen a draft of the Q&A and it does spell out that the HHABN is required in these situations, NAHC's Mary St. Pierre tells Eli.

Agencies should be telling patients about the F2F requirement at admission or shortly thereafter anyway, NAHC advises. But the trade group also "urges agencies to deliver HHABNs in advance of the actual discharge date, providing beneficiaries some additional time to meet the encounter requirements."

Don't forget: A newly updated HHABN form is required starting April 1. The form is at www.cms.gov/BNI/03_HHABN.asp.  "Prior formats of the HHABN with the expiration date of August 31, 2009, that are issued on and after April 1, 2011 will be considered invalid," warns regional home health intermediary Cahaba GBA in an e-mail message to providers.

Example: One HHA for a health system has undertaken an extensive education program since January with physicians, discharge planners, etc., St. Pierre relates. It is currently receiving back only about 4 percent of F2F documents.

Those experiences were echoed by forum callers. "I'm so frustrated by the face-to-face requirements," nurse Maria Thacker, owner and director of Tender Nursing Care in Reynoldsburg, Ohio, said in the forum. The F2F issue is complicated in Ohio, where the Medicaid program also is enforcing a new F2F requirement.

"Where is my relief when I provide services ... and can't get paid for it ... because the physician refuses to sign the face-to-face? Or the physician writes garbage on the face-to-face? Or the physician signs it and sends it back with nothing written on it?" Thacker asked CMS officials in the call.

"So far this trial period is not going very well," Thacker continued.

Physicians are requiring a lot of coaching and are returning F2F documentation slowly with subpar results, another caller said.