Guest Blog: Fraud and Abuse Tied to MD Face-to-Face Encounters

The following is a guest blog post on fraud and abuse issues by Robert W. Markette, Jr., CHC, Of Counsel for
Benesch Friedlander Coplan & Aronoff LLP. Mr. Markette’s primary areas of practice are health law and litigation and his wide range of health care clients includes home health, hospice and private duty providers.

Mr. Markette is also responsible for assisting the Home Care Alliance with its “Keeping it Legal in Home Care” resources on patient choice.

To view the entire article, click the link after the introduction:

As home health and hospice care continue to become more and more competitive and reimbursement continues to decline, referral sources are discovering new ways to leverage this for their own benefit. Two new examples include physicians requesting “administrative fees” to complete face to face paperwork and referral sources seeking “donations” from providers to defray the cost of capital equipment and other improvements. Providers need to understand the risks in these arrangements in order to avoid entering into arrangements that place them in violation of the Anti-Kickback Statute and/or the Stark Law.

The entire article from Mr. Markette is available here.

 

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FYI: “Home Health Prospective Payment System” Fact Sheet Revised

The Medicare Learning Network has recently released the revised “Home Health Prospective Payment System” fact sheet and is now available in downloadable format. It includes the following information: background, consolidated billing requirements, criteria that must be met to qualify for home health services, coverage of home health services, elements of the HH PPS, updates to the HH PPS, and healthcare quality. This can be used as a handy tool for new employees to home health care!

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CMS Responds to Congressional Letter on MD Face-to-Face

Congressman Jim McGovern, along with the rest of the state’s Congressional Delegation, received a response to a letter sent to the Centers for Medicare and Medicaid Services (CMS) that reflected the struggles of home health providers in Massachusetts relative to the physician face-to-face encounter requirement.

Unfortunately, the response from CMS is mostly a reiteration of the reasoning behind the rule and a commitment to monitor the implementation of the policy “to ensure that there are no unintended disruptions in access to medically necessary home health care for our beneficiaries.”

For more on the Physician Face-to-Face Encounter Requirement, see previous posts on the subject.

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CMS Proposes Medicare Home Health Payment Changes for 2012

The Centers for Medicare and Medicaid Services (CMS) have issued a proposed rule regarding payment changes as well as revisions to the physician face-to-face and therapy assessment rules.

Below is a summary of the most noteworthy aspects of the proposed rule provided by the National Association for Home Care & Hospice (NAHC):

1.       Proposed 2012 payment base episode rates are reduced to $2112.37 from the current $2192.07. This is a reduction of approximately 3.56%.

2.       The rate changes are due to a proposed 2.5% market basket index inflation update, a 1 point reduction in the MBI under the health care reform law, and a 5.06% case mix creep adjustment.

3.       The increase in the case mix creep adjustment is due to the evaluation of 2009 coding weight changes. CMS found that ¾ of the coding increases was a result of increases in therapy visits above the 14 and 20 visit thresholds.

4.       The 3.56% rate reduction will impact individual providers unevenly. CMS proposes to make significant changes in coding weights by eliminating hypertension as a factor in the calculation, reducing the weights on therapy episodes, and increasing weights on non-therapy episodes. Providers with high volumes of therapy cases could see greater net rate reductions. A provider-specific analysis using the provider’s particular case mix is the only reliable way to assess impact.

5.       CMS proposes to change the face-to-face rule and allow one physician to do the encounter and report the information to another physician who completes the certification and plan of treatment documentation. This should help in circumstances where a patient is under the care of a hospitalist who transfers the patient to a community physician.

6.       CMS proposes to clarify the therapy assessment standard where more than one discipline is involved.

The proposed rule on rates is in line with what had been expected. Nevertheless, that does not turn a lemon into lemonade. The change on the face-to-face rule is appreciated, but will only make a slight improvement as the documentation requirements remain a problem.

CMS also posted the proposed rule on the Medicaid face-to-face encounter requirements. The proposal aligns the Medicaid time frames with the Medicare time frames while providing some flexibility to states to determine other aspects such as the content and form of documentation. The proposal also reaffirms CMS’s position that a homebound requirement in Medicaid home health is not permitted and that services can be provided outside the home. Finally, the proposal offers clarifications on the coverage of medical supplies and equipment.

Another summary is available in a press release issued by CMS with a few more specifics on payment. The Home Care Alliance is working on a specific analysis regarding the payment changes based on the northeast’s wage index and will have that available soon.

See links to the specific proposed rules in the Federal Register below:

• Medicaid Face-to-Face Proposed Rule
• Home Health Prospective Payment System Rate Update for Calendar Year 2012

 

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MA Congressional Delegation Weighs in on Physician Face-to-Face Requirement

The Massachusetts Congressional Delegation has stepped up again, this time sending a letter to CMS Administrator Dr. Donald Berwick with concern over the physician face-to-face requirement.

Every member of the delegation – Senators Kerry and Brown, as well as US Reps Markey, Frank, Neal, Olver, McGovern, Tierney, Capuano, Lynch,  Tsongas and Keating – signed onto the letter noting that the Massachusetts health care community has made considerable efforts to comply with the rule, but the paperwork burden and duplicative nature of the requirement are proving problematic and that CMS should consider changes.

The letter itself is available here and the Home Care Alliance greatly appreciates the work and support from the Congressional Delegation.

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HCA Revamps Physician Face-to-Face Guidance

The Home Care Alliance has newly revamped documents available for helping home health agencies work with physicians relative to the face-to-face encounter requirement.

Please feel free to utilize and distribute the documents below, which include a fact sheet on the requirement, a sample documentation guide, and a tip sheet for terms that can be used in the “brief narrative” portion of the document.

• Physician Face-to-Face Fact Fact Sheet

• Documentation Guide and Tip Sheet

The Home Care Alliance continues to work with association partners such as the Massachusetts Medical Society, Massachusetts Hospital Association, Mass Senior Care, LeadingAge Massachusetts and others to ensure that physicians in every setting know about and properly cooperate with the requirement.

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Physician Face-to-Face Encounter Update: New Q&As

The Centers for Medicare and Medicaid Services (CMS) have posted new guidance regarding the physician face-to-face requirement in order for patients to receive Medicare home health services.

Questions & Answers have been updated periodically by CMS and a new round has just been made available.

The new Q&A’s include:

• When can the HHABN Option 2 be used if a patient fails to have a face-to-face encounter with the certifying physician?

• What is an example of the physician’s narrative on the face-to-face documentation?

• Can documentation requirements for the face-to-face encounter be satisfied if the certifying physician’s staff complete the document as part, or addendum to the certification using the patient’s medical record & physician reviews and signs?

Also, if you are from a home health agency and have not already done so, please comment on a national Face-to-Face Encounter Requirement Survey. Your feedback on whether the report reflects the issues your agency is facing will be instrumental in the Home Care Alliance’s advocacy and meetings with federal elected officials taking place at the end of March. You can comment on this newsfeed post or email James Fuccione at HCA.

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Physician Face-to-Face Encounter National Survey: Please Comment

The Home Care Alliance will be traveling to Washington DC later this month to advocate on many issues of concern, including the physician face-to-face encounter requirement set to be enforced starting April 1.

Please see this summary of results from a nationwide survey and let the Alliance know if your agency is in line with how other home health providers from across the country answered.

The survey was conducted by the National Association for Home Care & Hospice (NAHC) and is important in helping HCA shape the message that will be delivered to our Congressional delegation and other key government officials.

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CMS Clarifies use of HHABN for Face-to-Face Requirement

On the CMS Home Health, Hospice & DME Open Door Forum held today, March 2nd.,  staff from CMS discussed the use of the HHABN when discharging a patient because there was no F2F encounter within the required time frame.  This is a clarification of an earlier policy which said that the HHABN was not to be used in this situation.

Option BOX 2 can be used because the agency is ending services for administrative reasons such as lack of a F2F encounter.  It is a change of care notice only and there is no beneficiary liability for the care provided. Further written clarification from CMS will be forthcoming.

Physician Face to Face Encounter Update

The Home Care Alliance wrote an article in the Massachusetts Medical Society’s newsletter in an effort to further educate physicians on the CMS face-to-face encounter requirement. The article was written at the beginning of the year and published in the February edition of “Vital Signs,” the MMS newsletter, although much has happened since then.

With one month left until the April 1st enforcement deadline, the Alliance continues to provide updates as they become available. To that end, some new important Q&A’s have been posted on the CMS website, which are available here.

A few of the new Q&A’s are listed below:

• Is the face-to-face encounter requirement effective only for patients admitted to home health (i.e. have a new start of care) January 1st, 2011 and later?

• Do both the plan of care and the certification have to be signed by the same physician?

• The final rule references homebound status and skilled need.  Is the documentation of the clinical findings from the face-to-face encounter sufficient?

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