With the Affordable Care Act in 2011 came the mandated face to face requirement (F2F) for Medicare beneficiaries receiving home health services. In July 2016, this requirement was extended to Medicaid home health services.  

Since its’ inception, F2F has been a thorn in the side of many Home Health Care agencies. The guidelines and recommendations were often unclear and forever changing. Agencies were being held accountable when the physician narrative failed to meet the requirement, resulting in denied claims and payment recoupment.

The final rule which was released in January 2015, waived the narrative requirement, added some clarity but also placed additional burdens on HHAs.

Following the release of the final rule, CMS outlined these updated documentation requirements:

1. The certifying physician’s medical records, and/or the acute/post-acute care facility’s medical records (if the patient is directly admitted to home health) are used as the basis for determining the patient’s eligibility for the Medicare home health benefit.
2. Documentation from the medical records must be provided, upon request, to the home health agency, review entities, and or CMS. An HHA must be able to provide, upon request, to the home health agency.
3. The certifying physician and/or acute/post- acute care facility medical records must include information justifying the referral for home health care services.  This includes documentation showing the patient’s:
• Need for the skilled services; and
• Homebound status.
4. The certifying physician and/or acute/post- acute care facility medical records must include the actual clinical note for the FTF encounter visit that demonstrates that the encounter:
• Occurred within the allowed timeframe,
• Was related to the primary reason the patient requires home health services; and
• Was performed by an allowed provider type (either a certifying physician, a physician who care for the patient in an acute or post-acute facility or a qualified non-physician practitioner (NPP) working under the supervision of the certifying physician or an acute or post-acute care physician.
5. Information from the home health agency can be incorporated into the certifying physician’s medical record and used to support the patient’s homebound status and need for skilled care. This information must be corroborated by other medical record entries in the certifying physician’s and/or the acute/post- acute care facility’s  medical record for the patient and signed and dated by the physician to indicate acceptance into their medical record.
• The documentation must include the date of the FTF encounter; and
• The certification must be completed and signed by the certifying physician prior to billing.

Source: https://www.cgsmedicare.com/hhh/education/materials/pdf/FTF.pdf

CMS also reminded certifying physicians that they are responsible for providing the medical documentation necessary to support that the patient is eligible for the home health benefit. Medicare will review only the certifying physician’s medical record for the patient to determine eligibility at the start of care. If the patient’s medical record is not sufficient, Medicare will not pay for home health services. Further, if the home health agency’s claim is not covered because of insufficient documentation, Medicare also will not cover or pay the physician’s claims for certification or recertification of eligibility for home health services.

To be compliant with Medicare and minimize takebacks:

1. Review your agency’s current procedures and practices. Are you obtaining the F2F prior to the initial assessment or trusting that the patient will see their physician within 30 days after the assessment?
2. Provide staff with additional training. Their initial assessment, comprehensive assessment or summary documentation can now be used to meet the requirement, as long as there is corroborating entries in the patient’s medical record and the physician agrees to enter the documentation into the patient record.
3. Develop a procedure to track and review FTF documentation prior to billing.
4. If the physician’s signature is not legible, obtain an attestation that can be used as verification.

Understandably, most HHAs would have preferred to have seen the FTF rule completely eliminated, but since it is here to stay, there are ways to develop best practices to minimize denials.