Part B Insider (Multispecialty) Coding Alert

Published on Sat Apr 03, 2010 PDF

The new health care reform package will require the physician to see the patient in person before certifying him.

The new health care reform package that President Obama signed into law last month is throwing a lot of new requirements at providers, and the result can sometimes be confusion.

For example: In the upcoming home health agency prospective payment system proposed rule, CMS will be issuing a new requirement that a physician see a patient face to face before certifying her.However, even though it's in the Home Health Agency (HHA) rule, the requirement will apply to hospice patients only, CMS clarified in the April 14 Open Door Forum for home care providers.

Under the Patient Protection Affordable Care Act (PPACA), for services on and after Jan. 1, 2011, a physician or nurse practitioner must have a face-to-face encounter with hospice patients to determine their continued eligibility, CMS's Randy Throndset explained. The requirement applies to recertifications at 180 days and each subsequent recertification.

That physician or non-physician practitioner also must attest that such a visit took place, Throndset added.

Plus: Hospices with a large ratio of long-stay patients will have their care medically reviewed, the legislation adds.

This hospice provision will most likely go into the HHA proposed rule because there isn't time for a hospice payment proposed rule before 2011 rates must take effect in October, Throndset explained.

For more on how the PPACA health care reform affects your practice and your Medicare payments, sign up for the FREE May 11th webinar, "Find Out What the Reform Bill Means for Your Practice," led by Part B Insider editor Torrey Kim, CPC. Visit https://www.aapc.com/codes/ for details.