Medicare Compliance & Reimbursement

If your state hasn't adopted a Medicaid face-to-face requirement yet, it will soon.

Just when you're getting used to the Medicare face-toface rule, you'll need to adjust to one on the Medicaid side -- and it won't be easy. The Centers for Medicare & Medicaid Services proposes a Medicaid physician faceto- face encounter rule that looks nearly identical to the one for Medicare, according to a proposed rule published in the July 12 Federal Register.

Under the rule, which doesn't contain an implementation date, physicians would need to conduct an F2F encounter 90 days before or 30 days after the start of home care services and provide documentation stating that the encounter occurred and explaining why the clinical findings from it support home care eligibility. The rule aims to "align the timeframes with similar regulatory requirements for Medicare home health services," CMS notes in the rule.

Like the Medicare requirement, the Medicaid rule proposes to allow certain non-physician practitioners to conduct the F2F encounter and report their clinical findings to the certifying physician. And the rule also proposes to allow physicians in acute or post-acute facilities do the same, like in the 2012 PPS proposed rule .

Some states, like Ohio, already have Medicaid F2F rules in effect. HHAs there have reported the same types of problems associated with the Medicare requirement. Other states, like Florida, have other physician encounter requirements in place. The Florida rule for the doc to see the patient 30 days prior to initiation of home care services "may meet the federal standard," hopes the Home Care Association of Florida.

Under the rule, states will be free to impose some additional requirements related to the F2F mandate. "We are not prescribing at the Federal level the specific elements necessary to document the face-to-face encounter, as that is a matter of clinical judgment that could vary according to the individual circumstance," CMS says. "However, States may choose to implement a minimum list of required information to adequately document the encounter."

The F2F requirement has already introduced unnecessary chaos into agencies' operations, says Bob Wardwell, the former CMS official who headed PPS's design and implementation. "Adding Medicaid to the mix may further confound efficient administration of the program," Wardwell worries.

As with the Medicare F2F rule, agencies and physicians will face a major workload addition under the Medicaid requirements. However, CMS estimates in the rule that it will take physicians a mere 10 minutes to fill out F2F documentation.

Attorney Robert Markette Jr. with Benesch/Dann Pecar in Indianapolis scoffs at that estimate. "I think the physicians disagree with that," Markette tells Eli. Plus, there's no mention of the time HHAs are spending convincing doctors to complete the paperwork, Markette adds. "I imagine HHAs will spend a lot of time trying to convince physicians to comply or explaining to patients they need to consider another doctor."

The rule will be bad news for many agencies' referrals. "When this rule goes final, the physicians who were already unhappy about the Medicare face-to-face are going to become even unhappier," Markette predicts.

Note: The Medicaid F2F proposed rule is online at www.gpo.gov/fdsys/pkg/FR-2011-07-12/pdf/2011-16937.pdf.Comments are due by Sept. 12.