CMS Proposes New Face-to-Face Encounter Requirement

Good Morning MFS Bloggers, The following excerpt was taken directly from CMS’s recently published proposed rule on the POC face-to-face physician encounter requirement:

“On March 23, 2010, the Patient Protection and Affordable Care Act (The Affordable Care Act) of 2010 (Pub. L., 111-148) was enacted. Section 6407 (a) (amended by section 10605) of The Affordable Care Act amends the requirements for physician certification of home health services contained in Sections 1814 (a)(2)(c) and 1835 (a)(2)(A) by requiring that, prior to making such certifications, the physician must document that the physician himself or herself or specified non-physician practitioner has had a face-to-face encounter (including through the use of telehealth, subject to the requirements in section 1834(m) of the Act), with the patient incident to the services involved.
Therefore, we propose revising §424.22 (a)(1)(v) such that for initial certifications, prior to a physician signing that certification and thus certifying a patient’s eligibility for the Medicare home health benefit, the physician responsible for certifying the patient for home health services must document that a face-to-face patient encounter (including through the use of telehealth if appropriate) has occurred no more than 30 days prior to the home health start of care date by himself or herself, or by an authorized non-physician practitioner (as specified in sections 1814(a)(2)(c) and 1835(a)(2)(A) of the Act) working in collaboration with or under the supervision of the certifying physician as described above.
Similarly, we prose to revise §424.22(a)(1)(v)(B) to reflect that if a home health patient has not seen the certifying physician or one of the specified non-physician practitioners as described above, in the 30 days prior to the home health episode start of care, the certifying physician or non-physician practitioner, would be required to have a face-to-face encounter (including the use of telehealth, subject to the requirements in section 1834(m) of the Act and subject to the list of Medicare telehealth services established in the most recent year’s physician fee schedule regulations) with the patient within two weeks after the start of the home health episode to comply with the requirements for payment under the Medicare program.
We propose implementing the above face-to-face patient encounters provisions as they relate to home health episodes beginning 01/01/2011 and later.”

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