A recent study by the Office of Inspector General found that the face-to-face rule for home health fails nearly one third of the time. According to the report, 32 percent of home health claims requiring face-to-face encounters failed to meet Medicare rules, resulting in $2 billion in payments that should not have been made. Furthermore, the report says physicians inconsistently completed the narrative portion of the face-to-face documentation and CMS oversight is minimal, at best.
OIG reviewed 644 face-to-face encounter documents, interviewed the four Home Health and Hospice Medicare Administrative Contractors (HH MACs), and reviewed guidance documents and policies from CMS. For 32% of home health claims that required face-to-face encounters, the documentation did not meet Medicare requirements, resulting in $2 billion in payments that should not have been made. Furthermore, physicians inconsistently completed the narrative portion of the face-to-face documentation. Some face-to-face documents provide information that, although not required by Medicare, could be useful, such as a printed name for the physician and a list of the home health services needed. CMS oversight of the face-to-face requirement is minimal.
Based on its findings, OIG is recommending that CMS:
(1) consider requiring a standardized form to ensure that physicians include all elements required for the face-to-face documentation,
(2) develop a specific strategy to communicate directly with physicians about the face-to-face requirement, and
(3) develop other oversight mechanisms for the face-to-face requirement. CMS concurred with all three of these recommendations.