The Centers for Medicare and Medicaid Services (CMS) will issue a proposed rule that will eliminate the requirement of a narrative as part of the documentation of face-to-face encounters. The proposed rule, if finalized, will also:

• Update Home Health Prospective Payment System (HH PPS) rates effective on January 1, 2015;
• Change HH PPS case-mix weights;
• Change home health quality reporting program requirements;
• Change therapy reassessment time frames to at least once every fourteen calendar days;
• Revise speech-language pathology (SLP) personnel qualifications; and
• Limit reviewability of civil money penalties imposed on agencies as a result of survey deficiencies.

If the proposed rule is finalized, the most welcome change may be elimination of the narrative portion of the documentation of face-to-face encounters.

The basis for CMS’ proposal to eliminate the narrative portion of face-to-face documentation is that there should be sufficient evidence in patients’ medical records to demonstrate that patients meet the Medicare home health eligibility criteria.

Specifically, CMS proposes the following:

• The narrative requirement would be eliminated. Certifying physicians will still be required to certify that face-to-face patient encounters related to the primary reasons patients require home health services occurred no more than 90 days prior to the home health start of care date or within 30 days after the start of home health care services and were performed by a physician or non-physician practitioner, if allowed, and to document the date of encounters as part of the certification of eligibility. When physicians order skilled nursing visits for management and evaluation of patients’ care plans, physicians will still be required to include brief narratives that describe clinical justification of this need in order to certify/recertify eligibility.

• To determine whether patients are or were eligible to receive services under the Medicare home health benefit at the start of care, CMS will review only medical records for patients from certifying physicians or acute/post-acute facilities, if patients were directly admitted to home health from these facilities. If patients’ medical records used by physicians to certify eligibility are insufficient to demonstrate that patients are eligible to receive services, payments will be withheld.

• If HHA claims are non-covered, Physicians’ claims for certification/recertification of eligibility for home health services will not be covered because the certification/recertification of eligibility was incomplete or because there was insufficient documentation to support that patients were eligible for the Medicare home health benefit. This proposal will be implemented through future sub-regulatory guidance.

CMS also addresses the issue in this proposal of whether face-to-face encounters are required when beneficiaries are discharged from home health with goals met/no expectation of return to home health care and readmitted less than 60 days later. In these situations, the second episode will be considered a certification, as opposed to a recertification, because agencies will be required to complete a new start of care OASIS to initiate care. The second episode will be considered a subsequent episode for payment purposes because there was no gap of 60 days or more between the first and second episodes of care. CMS proposes, therefore, to clarify that requirements for face-to-face encounters are applicable for certifications, but not recertifications, rather than initial episodes.

In other words, CMS proposes to clarify that certification occurs at any time that a new start of care OASIS is completed in order to initiate care. If, for example, patients are transferred to hospitals and remain there after day 61 or after the first day of the next certification period, new start of care OASIS must completed when such patients return home. The new episode is not considered to be continuous, so face-to-face encounters must be documented as part of the process of certifying patients’ eligibility.

Agencies need all of the relief they can get from current requirements regarding documentation of face-to-face requirements. Now let’s hope that CMS will stop audits and denials of payment based on insufficient narrative documentation of face-to-face requirements!

©2014 Elizabeth E. Hogue, Esq. All rights reserved.