Congress Issues Report to CMS Asking it to Justify its Face-to-Face Policy

As part of its analysis of the ongoing face-to-face issue, Inside Health Policy recently summed up the continuing frustration the home care and hospice community feel surrounding the face-to-face requirement:

“[The Home Care] Industry has viewed the Affordable Care Act’s face-to-face requirements as flawed and unclear. As part of the face-to-face documentation, a physician narrative was required to describe a patient’s clinical conditions and why a beneficiary needs home health care. The National Association for Home Care and Hospice sued CMS over the face-to-face requirements and physician narrative earlier this year because of confusion around what the narrative required. Home health providers said they were seeing claims denied because of documentation problems over which they had no control.

In the home health final pay rule, CMS eliminated the physician narrative requirement from the face-to-face documentation following the lawsuit. The changes are set to go into effect in 2015.

The US Department of Health and Human Services, HHS, in a recent report on the agency’s finances, also said that the face-to-face denials were driving up Medicare’s improper payment rates.

“HHS believes clarifying the face-to-face requirements will lead to a decrease in these errors and improve provider compliance with regulatory requirements, while continuing to strengthen the integrity of the Medicare program,” HHS’ financial report says.

Bill Dombi, vice president for law at the National Association for Home Care and Hospice, noted the bi-partisan, bicameral support behind the report’s comments on face-to-face issues, and said that support backs up the industry’s concerns. Some lawmakers have also recently pushed CMS to consider a settlement for home health denials that have occurred because of face-to-face documentation issues.

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