Face to Face Documentation Requirements


Face-to-Face Documentation Requirements

The Affordable Care Act required that a physician document that the physician or an applicable non-physician practitioner has had a face-to-face (F2F) encounter with a patient as part of the eligibility criteria for home health services (read the provision here). In implementing this provision, the Centers for Medicare and Medicaid Services (CMS) required that the physician also document why the individual is homebound and how the patient's clinical condition supports the need for skilled services. The documentation must be a separate and distinct section of, or an addendum to, the certification.

Initially, CMS required that this information be provided by the physician in a "narrative" incorporated into the physician record. As of Jan. 1, 2015, the narrative is no longer required. However, the physician must document in his or her record that a face-to-face encounter occurred within the timeframe specified by CMS and the physician's record must contain evidence that the individual is homebound and in need of skilled services. It is no longer sufficient for information supporting that the beneficiary is homebound and in need of skilled services to be located in the home health agency's plan of care.

On June 23, 2015, Sens. Robert Menendez, D-N.J., and Pat Roberts, R-Kan., introduced legislation in the Senate that offers a real solution to the challenges faced by home health providers. The legislation provides common-sense fixes to Medicare documentation problems and much needed relief to the documentation of a face-to-face visit. The legislation provides relief from past claims denials and improves the approach CMS uses to collect evidence that beneficiaries are eligible for home health services moving forward.

VNAA worked hard on the development of this comprehensive legislation and commends Menendez and Roberts for their leadership.

The VNAA has significant concerns about the implementation of these documentation requirements. We are concerned about the lack of clarity around what constitutes adequate documentation, the high rate of Additional Document Requests (ADRs) and payment denials on the part of some MACs, and the insufficient education of referring providers by CMS. We seek immediate relief for past denials and a clearer, more workable solution moving forward. Specifically, we seek:

  • Allow providers to resubmit claims that were previously denied due to the face-to-face documentation requirements; and
  • Prohibit audits on the face-to-face requirements for claims on discharges before Jan. 1, 2015 that have yet to be submitted or that have been paid but not audited.
  • Limit the information that CMS can collect with respect to the face-to-face visit to the date of the encounter;
  • Require CMS to work with stakeholders on a streamlined, standardized approach to collecting information supporting that the beneficiary meets the other criteria for home health services (i.e., homebound status, clinical basis for skilled services);
  • Require CMS to allow home health providers to complete the standardized document for review and approval by the referring physician and for incorporation into the physician's (or the facility's) medical record for the patient;
  • Waive the documentation requirements for individuals who were recently released from an inpatient facility;
  • Broaden the range of providers who can conduct the face-to-face encounter;
  • Broaden the use of telehealth to meet the face-to-face encounter requirements; and
  • Require CMS conduct extensive stakeholder education and conduct oversight of MAC application of the policy.

VNAA has engaged with CMS, Congressional staff, state home care associations, and other stakeholders to advance these policies. See below for a selection of written comments that VNAA supported, either through developing directly or in collaboration with state associations and Members of Congress:

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