Medicare Compliance & Reimbursement

Confusing and overlapping requirements exceed intent of the law, say commenters.

Commenters on the 2014 home health PPS rule seem united in bemoaning the burdens placed by the physician face to face documentation requirements, though they realize that it’s here to stay.

The Centers for Medicare & Medicaid Services (CMS) is “mandated by the [Affordable Care Act] to implement the home health F2F physician encounter requirement,” observed MidWest Care Alliance’s Jeff Lycan in MCA’s comment letter.

But CMS implemented regulations on the requirement much more strictly than required by Congress in the ACA. For example, the law suggested a six-month window for the encounter, noted rehab chain HealthSouth, which operates more than 20 HHAs. Instead, CMS gives agencies 120 days for the F2F encounter to occur — 90 days before and 30 days after. “To align this requirement with the legislative intent in ACA §6407 … we urge CMS to increase the window to at least 6 months,” Health-South said in its letter.

More importantly to many, CMS has the discretion to ax the physician narrative requirement altogether. That’s the component that is often causing the documentation headaches and denials.

“This is an overkill provision plain and simple,” financial consultant John Reisinger with Innovative Financial Solutions for Home Health in Tampa, Fla., told CMS in his comment letter.

Seventy-five lawmakers agree with agencies and signed onto a letter urging CMS to revise its F2F requirements. “While we support the need for direct encounters between patients and physicians to occur, we are uncertain why this method for implementing the F2F requirement was chosen,” says the letter sent to CMS last month. “The current regulations contain complicated, confusing, and overlapping documentation requirements that exceed the intent of the law passed by Congress. These requirements have imposed a significant burden on home health providers and physicians in our districts,” says the letter circulated by Reps. Tom Reed (R-N.Y.), Paul Tonko (D-N.Y.), Chris Smith (R-N.J.), and Robert Andrews (D-N.J.).

“We are simply asking that CMS considers modifying this requirement to allow that the F2F mandate is met through the completion and collection of the separately signed and perhaps modified 485 form,” the letter urges.

“We are asking that CMS review an expensive and unnecessary regulatory burden that presents an unfair barrier to patients receiving home health care services,” Rep. Reed says in a release. “The last thing we want is to provide a disincentive for physicians to recommend home health services.”

HealthSouth also wants to see CMS dial back its F2F requirements for patients coming out of inpatient facilities, the company said in its letter.

“Patients arriving on an HHA census from a formalized discharge planning process, like those processes undertaken by general acute care hospitals, IRFs, and long-term acute care hospitals, should not be forced to undergo duplicative paperwork and certification associated with the medical necessity of home health services,” HealthSouth said. “The discharging physician from an acute inpatient setting has already attested to it.”

Don’t hold your breath: Observers don’t expect to see any F2F changes in the 2014 HH PPS rule CMS will probably issue next month. But they do hope to see CMS action on the issue in the future as increasing claims denials take their toll on already strapped HHAs.