Eli's Hospice Insider

Published on Wed Aug 17, 2011 PDF

CMS clarifies what to do when the face-to-face requirement isn't fulfilled.

Complying with the hospice face-to-face physician encounter requirement will geta little easier under new rules taking effect Oct. 1, but tripping up on your F2F documentation will get easier too.

"We are finalizing the policy to allow any hospice physician to perform the faceto- face encounter regardless of whether that same physician recertifies the patient's terminal illness and composes the recertification narrative," the Centers for Medicare & Medicaid Services says in the 2012 wage index final rule published in the Aug. 4 Federal Register. Hospices that use this policy must remember to take the next step beyond the encounter. New regulatory language will "state that the attestation of the nurse practitioner or a non-certifying hospice physician shall state that the clinical findings of that encounter were provided to the certifying physician, for use in determining continued eligibility for hospice," CMS says in the rule.

CMS loosened up the hospice physician requirement, but it turned down commenter suggestions to allow physician assistants or clinical nurse specialists to conduct the F2F encounter. That's because it's prohibited by the statutory language in the Affordable Care Act, CMS maintains.

CMS also rejected commenter suggestions to allow community physicians and nurse practitioners to conduct the F2F visit. "The Act requires that the physician or NP conducting the face-to-face encounter must be a hospice physician or NP," CMS says in the rule.

Tip: Don't forget to appropriately document such doc services in the patient record and distinguish them from the F2F encounter, reminds the National Association for Home Care & Hospice.

One commenter asked CMS to make the new rule retroactive to the beginning of the F2F requirement. But CMS maintains that the provision takes effect Oct. 1, 2011.