Medicare Compliance & Reimbursement

Home care providers may be working hard to comply with the physician face-to-face encounter rule after the April 1 enforcement date, but they're still looking for relief from the new burden.

The National Association for Home Care & Hospice is tracking the results of the F2F requirement with a one-page survey providers fill out weekly. "The purpose of this tracking effort is to gather the data needed to support advocacy efforts to rescind and reform the face-to-face encounter requirement," NAHC says in its member newsletter. "The potential for doing so hinges on whether patients are adversely affected in terms of their access to care."

Using a weekly survey aims to "provide near real-time identification of outcome concerns that could spur Congress into action on the issue," NAHC adds. The survey focuses on three potential adverse outcomes for patients: (1) denial of access at admission; (2) delayed admission; and (3) loss of access after the 30-day period from the start of care in which the encounter must be completed.

The Visiting Nurse Associations of America is also monitoring for F2F problems, the trade group says in a release. VNAA is working "with VNAA members and others to document and report the problems implementing this provision that will most certainly delay or limit access to care for some patients," it notes.

"We are deeply disappointed that more time was not provided as there was a strong consensus among diverse groups that it takes about six months for an educational and system change of this magnitude," VNAA's Andy Carter says in the release. "Our nonprofit members are most likely to take the risk of serving patients who may not have a primary care physician and may not be able to get the documentation done within the timeframe."

Resource: VNAA has F2F sample documents, some of which are accessible to the public, at http://vnaa.co/F2Fhelp.

Hospices now have legislation to help them lobby for F2F reform. Sens. Ron Wyden (D-Ore.) and Pat Roberts (R-Kan.) have introduced legislation that would amend "the requirements that all hospice patients meet face-to-face with a doctor before admission to a hospice, by allowing nurse practitioners and physician assistants and others to conduct the required face-to-face interview," according to a press release from Sen. Wyden's office.

The bill also would allow valid F2F encounters to occur up to seven days after admission in the third benefit period. The seven-day post-admission window would apply for new admits or other "exceptional circumstances," says S. 722 introduced on April 4.

The F2F change "ensures program integrity while also preserving access to services, especially in rural areas where great distances can create unwanted impediments," Sen. Wyden said in introducing the bill.

The bill "sets realistic requirements for a face-to-face encounter," Wyden said. The current F2F rule "has caused a significant burden on our hospice communities, especially those in rural areas. The limits on who can conduct the face-to-face encounter and the timeline for compliance do not reflect the operational realities of hospice programs, especially for small and rural hospices."

The bill also calls for other hospice reforms, including requiring a demonstration project for payment reform ideas before implementing nationwide changes and requiring hospices to undergo surveys every three years.