Face to Face Encounter Documentation, The IMPACT Act, and Other Home Care and Hospice Developments

“Face to Face Encounter Documentation”  CMS released its proposed rule on Face to Face Encounter documentation in November, and it builds upon the ACA’s statutory requirement that a physician provide documentation of “face-to-face encounters” in order to certify a patient’s eligibility for the home health benefit under Medicare.  The law requires that the clinical findings of a physician relate to the primary reason for the provision of home health services.  The proposed rule now requires that in lieu of a physician narrative, the documentation should include the date of the face-to-face encounter and the medical records of the acute and post-acute organization. While this may seem as though it relieves some of the burden on physicians, the proposed rule contains a “sign-off” requirement of the physician. Face-to-face encounters are required for certifications of eligibility for the reimbursement of home health agencies. T

he IMPACT Act is now law. Bottom line: Medicare certified hospice providers are now subject to mandatory surveys every three (count’em 3) years for the next 10 years; if a to-be-later-determined percentage or number of hospice patients receive hospice care for over 180 days, CMS will require medical reviews; and the index of the so-called “hospice cap” will now be based upon the hospital market basket and not the medical expenditure component of the Consumer Price Index for Urban Consumers. The mandatory surveys will be conducted by the state or accredited surveyors. How the threshold determination for arriving at the percentage or number of patients with >180 days will be set forth in rulemaking. The new hospice cap will go into effect in 2016, so one hopes that there is time to wrestle with intact and discharge studies in time to review the total expenditures.

Home Health Quality Reporting Program – Required as a Condition of Participation. For some time the conditions of participation in the Medicare Program for home health agencies have required the submission of the Outcome and Assessment Information Sets forms.  As of next July, home health agencies must submit OASIS assessments for episodes of care delivers to at least 70% of all patients. The penalty for failure to provide at least this percentage is a 2% reduction in payment.  By 2017, at least 90% of patients receiving care must be included within the OASIS assessment.

The trend of greater administrative attention to data reporting remains constant.