Home Health Training: Face to Face Requirements

There are specific provisions included as modifications to the home health benefit in PPACA designed to curtail fraud. One of them was modifying the certification requirements to include a face-to-face. The home health certification added a face-to-face requirement as part of PPACA. Read this expert information given by our speaker in a home health conference to know more.

And so this is a statutory change to eligibility or to payment for home health that there be a face-to-face encounter between the physician certifying the need for home health and the patient has received it. And the statute requires that it be a documented face-to-face encounter as per the changed home health rules.

Now, the statute gave CMS a little bit of authority or ability to alter those requirements in the sense of the timeframes in which the encounter is said to occur, et cetera.

But the bottomline of the face-to-face encounter and there were some specific comments that were received by the CMS prior to the final rule about, “Hey, this is the way that gets so burdensome. It's going to cause issues with the physicians,” et cetera because there's so much more we have to place on the physician at the start of care. And CMS pointed out they have no authority to change this. Now, in light of the comments about the burden and the difficulty with keeping some of these stuff, CMS did make some other changes to the existing home health guidelines.

For example, the timing of the face-to-face encounter for purposes of the start of care certification, they expanded the timeframe as per the recent healthcare rules. And so now, the face-to-face encounter must occur no more than 90 days prior to the home health start of care or within 30 days after the start of home health care.

So you can look back now from the start of care 90 days to see if there was a face-to-face encounter that meets this requirement before you have to consider getting that face-to-face encounter taken care of within the 30 days of the start.

So that might alleviate some of these because you may find, now going back 90 days which is some additional 30 days from the proposed rule, you're able to find an encounter to pull in that allows you to not have to ask the doctor or explain to the doctor, “Look, you're going to have to see this patient face-to-face in order to do the certification for the home health start of care.”

Now, it can't be any face-to-face encounter. This face-to-face encounter must be related to the primary reason the patient requires home health services.

So if the patient is getting home health for post-op recovery from a hip replacement, you're going to expect a face-to-face encounter, our speaker highlighted in the home health conference. But if for some reason, you either had a last face-to-face encounter with a physician signing a certification but unrelated to the surgery, you would need there to be a face-to-face encounter.

So you have to make sure that whatever face-to-face encounter the physician is pointing to is actually related to the reason for start of care for the home health care. If it's unrelated, then you're going to have to have the face-to-face encounter occur within 30 days at the start of care.

Our expert mentioned in a hospice conference that one of the things you have to look at now when the patient goes on to home health services is, “Was there a face-to-face encounter in the previous 90 days? And if there was, was it for a condition for which they received any home health services?” And if not, you need to make there is a face-to-face encounter within 30 days of the start of care.

Now, there has to be an encounter. It has to fit within the timeframe. And you have to document the encounter because one area that nurses and lawyers agree on, if you didn't document it, it didn't happen. And that surprisingly, both Congress and CMS want the encounter documented.
The final rule states that the documentation of the encounter must be a separate and distinct section of or an addendum to the certification. So you could amend your form so there's a place on the form where the doctor can document the encounter.

Given what's going to be involved, et cetera, it's probably simpler to do an addendum where the doctor can spell out the encounter and will discuss it. It has to be in the documentation. And given it has to be in the documentation, again, a separate piece is probably easier to deal with in trying to find a way to fit on to the form you're already using.

This document must be clearly titled, dated and signed by the certifying physician. Again, the physician signing off is certifying these things happened.

Now, obviously, you've got to include the date of the encounter as per the home health rules. The documentation must also state that the condition treated during the face-to-face encounter was related to the primary reason the patient requires home health services.

And the physician must explain why the clinical findings support that the patient is home-bound and in need of intermittent skilled nursing or therapy services. The physician has to explain that.

Probably one of the issues that Congress is concerned about, that led to this face-to-face requirement was physicians signing off on home health for patients that really didn't need home health. Now, we don't know that this is going to change anything because if the docs are willing to sign off on folks that don't need care in exchange for money, it's probably not going to pain them to then fill out an additional bit of narrative.

You can't fill out the narrative for the doc. You can't have the doc tell you it's on there and then you complete the form and send it to the doc for signature. The doc needs to do this because they're trying to put some burden on the doc as part of their fraud prevention measures as per the healthcare guidelines.

Now, there are some folks other than the doc who can perform the face-to-face encounter. And this is again spelled out. CMS puts in the rule but it was also spelled out in the Healthcare Reform statute. Obviously, the certifying physician but then the physician can have a nurse practitioner, clinical nurse specialist, certified nurse midwife or physician assistant perform the face-to-face encounter.

If someone other than the certifying physician – so one of these other four listed non-physician practitioners – performs the face-to-face, they will need to document the clinical findings and provide those clinical findings to the certifying physician.

The certifying physician will then take care of the rest of the documentation by looking at the findings and then reach in their conclusions and doing the certification as required because the physician has to do the certification according to the home health guidelines.

Get more home health and hospice updates like this; visit our home health conference page.