CMS Mandates New HHA Face-to-face Encounters
Know the specifics so you’ll be current with home health service requirements.
By Christopher A. Parrella, JD, CHC, CPC, CPCO
Effective April 1, the Centers for Medicare & Medicaid Services (CMS) implemented new face-to-face encounter requirements for home health services (MBPM126.96.36.199). This new rule requires the certifying physician document all face-to-face encounters conducted with patients.
NPPs also may perform face-to-face encounters, provided they inform the certifying physician regarding the clinical findings exhibited by the patient during the encounter. The certifying physician, however, must document the encounter and countersign the certification.
The following NPPs may perform face-to-face encounters:
- A nurse practitioner (NP) or clinical nurse specialist working in collaboration with the certifying physician in accordance with state law
- A certified nurse-midwife as authorized by state law
- A physician assistant (PA) under the supervision of the certifying physician
Encounter Documentation Requirements
The following face-to-face encounter elements are required:
- The date when the physician or NPP saw the patient and a brief narrative describing how the patient’s observed clinical condition supports the patient’s homebound status and need for skilled services.
- The certifying physician must document the encounter (handwritten, typed, or electronic health record (EHR)) either on the certification, which the physician signs and dates, or a signed addendum to the certification.
The certifying physician may choose to dictate the encounter. It also is acceptable for the physician/NPP to verbally communicate the encounter to the home health agency (HHA), where the HHA would then document the encounter as part of a certification form for the physician to sign.
The physician encounter must occur no more than 90 days prior to the home health start of care date, or within 30 days after the start of care.
In situations when a physician/NPP orders home health care for the patient based on a new condition inevident during a visit within 90 days prior to start of care, the certifying physician/NPP must see the patient again within 30 days after admission. Specifically, if a patient saw the certifying physician/NPP within 90 days prior to start of care, another encounter is necessary if the patient’s condition changed to the extent that practice standards indicate the physician/NPP should examine the patient to establish an effective treatment plan.
Exceptions to the encounter mandates are:
- If the home health patient dies shortly after admission to the home health agency but before the face-to-face encounter occurs
- If the intermediary determines a good faith effort existed on the part of the HHA to facilitate/coordinate the patient encounter
- If all other plan of care requirements are met, the certification may be deemed as complete
Acute/Post-acute Stay Encounters
A physician, such as a hospitalist who tends to a patient in an acute or post-acute setting who does not follow the patient when discharged may still certify the need for home health care and establish and sign Plan of Care form 485. The acute/post-acute physician would then transfer the patient’s care to a community-based physician, who assumes the patient’s care in coordination with the HHA.
Resource Tip: For information on hospitalist coding, billing, and documentation rules, see the article “Hospitalists: Focus on Coding, Billing, and Documentation” in this issue of Coding Edge.
A face-to-face encounter can also be performed via a telehealth service in an approved “originating site.” An originating site is considered to be the location of an eligible Medicare beneficiary at the time the furnished service (via a telecommunications system) occurs. Medicare beneficiaries are eligible for telehealth services only if they are presented from an originating site located in a Rural Health Professional Shortage Area (RHPSA) or in a county outside of a metropolitan statistical area (MSA).
Entities participating in a federal telemedicine demonstration project approved by (or receiving funding from) the Department of Health and Human Services as of Dec. 31, 2000 qualify as originating sites regardless of geographic location.
Originating sites authorized by law are:
- Office of a physician or practitioner
- Critical access hospitals (CAHs)
- Rural health clinics (RHCs)
- Federally qualified health centers (FQHCs)
- Hospital-based or CAH-based renal dialysis centers
- Skilled nursing facilities (SNFs)
- Community mental health centers (CMHCs)