A bi-partisan Senate letter raising questions and concerns about Medicare medical reviews and F2F denials was sent to CMS Administrator Marilyn Tavenner last week. The letter was initiated by Senator Kelly Ayotte and co-signed by Senator Jeanne Shaheen, along with seven other Senators from Vermont, Maine, Massachusetts and Connecticut.
“Home health agencies in our states are being overwhelmed by a significant increase in medical review activity, with millions of dollars in payment denials related to physician face-to-face documentation for medically necessary care provided to Medicare beneficiaries,” wrote the Senators. “Home health agencies in New England inform us that these reviews and payment denials, which they believe are in many cases unjustified, could jeopardize seniors’ access to home health care.”
The Senators asked Ms. Tavenner to:
- explain what steps CMS will take to ensure clarity of the F2F regulations,
- describe how patient care will not be compromised while F2F appeals are being considered,
- provide a list of outcomes of F2F denials and appeals across the country
- consider working with home health agencies to reopen or settle claims related to F2F
Senator Ayotte offered to initiate this letter after visiting with a Medicare patient cared for by the VNA of Manchester and Southern NH, and hearing concerns from many agencies about the deluge of ADRs and F2F denials. Senator Ayotte’s staff worked with HCANH and other Senate offices to craft a letter expressing the collective concerns of agencies throughout the New England. This effort was coordinated with the home care associations in neighboring states. Two Republicans, five Democrats and two independents signed onto the letter to CMS.
The Home Care Association of New Hampshire is grateful to Senator Ayotte and Senator Shaheen for responding to home health agency concerns. We encourage members to email the Senator Ayotte and Senator Shaheen to thank them for their attention to this critical issue.