CY 2012 Home Health Final Rule Makes Changes to Face-to-Face Encounter Guidelines

Good Afternoon MFS Bloggers!

The Affordable Care Act (the “ACA”) amended the requirements for physician certification of home health services to require that, as a condition of payment, prior to certifying a patient’s eligibility for the home health benefit, the certifying physician must document that the physician himself or herself, or an allowed nonphysician practitioner (NPP) working with the physician, has had a face-to-face encounter with the patient. HHAs have been required to comply with the face-to-face encounter requirements since April 1, 2011.

Importantly, CMS addressed what is called an “unintentional gap” in ACA by not explicitly including language that allows the acute or post-acute attending physician to inform the certifying physician regarding his or her face-to-face encounters with the patient to satisfy the requirement. CMS stated that ACA does not preclude a patient’s acute or post-acute physician from informing the certifying physician regarding his or her experience with the patient for the purpose of the face-to-face encounter requirement, much like a NPP currently can.

The final rule revises applicable regulations to incorporate CMS’ position: effective with starts of care beginning January 1, 2012, and later, for patients admitted to home health immediately after an acute or post-acute stay, the physician who cared for the patient in the acute or post-acute facility may perform the face-to-face encounter and communicate the clinical findings of that encounter to the certifying physician. CMS commented that the HHA may facilitate communications between the physicians, including sending the discharge plan to the certifying physician. The patient’s discharge summary or discharge plan can serve as the face-to-face documentation if it includes the signature of the certifying physician and the required content.

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