CMS Chimes in on Face to Face

CMS released two policy issuances that are worthy of note.

An update of the policy provisions on face-to-face certifications: This is not a new policy, but a codification of the 2015 regulatory amendments into the CMS manual. One somewhat interesting element is that CMS indicates that as a matter of medical review, the physician’s record should support the certification. Recently, CMS is communicating that the physician record sufficiency to support the certification is a medical review matter, not a policy one.   https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R91GI.pdf

An update of many of the manual provisions on coverage standards for the home health benefit. Included within the update are revisions on the face-to-face and physician certification requirements. While much of the revision is directly consistent with the language in the 2015 rule changes, there are a few items of particular note.

First, the policy sets out that HHAs must make an effort to get the signed physician certification prior to the end of an episode. Longstanding policy  simply required signed certifications prior to billing. While that remains the standard. The policy changes adds the requirement that an HHA cannot wait until the end of the episode to try to obtain the signed certification.

Second, more detail is offered on the requirement that the physician record is the basis for determining whether coverage criteria are met.  This change is presented in a somewhat confusing manner as it would not be logical to limit coverage determinations to a physician record for the entire episode while also requiring early physician certifications. A patient’s status in relation to coverage requirements can change following the physician certification and the end of an episode.

Third, CMS seems to be making a special effort to set out its policy that recertifications should include a physician’s projection on how much longer care would be needed by the patient. HHAs should guard against this matter in their recertifications.  https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R207BP.pdf