Effective April 1, 2011, physicians who order home care services for their Medicare patients must document that they had a face-to-face encounter with the patient prior to certifying the patient's eligibility for home care services.
The new requirement ensures that the certification is based on the physician's current knowledge of the patient's condition. The face-to-face encounter must occur within 90 days of the start of care. If the physician orders home health care based on a new condition not evident in the prior visit, the certifying practitioner must see the patient within 30 days of the start of care.
As part of the initial certification, the physician must document that he or she examined the patient, and the clinical findings which support the patient's homebound status and his or her need for covered home health services.
The face-to-face encounter can be satisfied if a non-physician practitioner (NPP), such as a nurse practitioner, physician assistant, certified nurse midwife or clinical nurse specialist, who is working for, or in collaboration with, the physician, sees the patient. In addition to the NPP, the new requirement allows inpatient facility physicians (such as hospitalists) who attended the patient in a hospital, skilled nursing facility or rehabilitation facility (but will not continue to treat the patient in the community) to certify the need for home health services based on their face-to face contact with the patient. The inpatient physician can establish and sign the plan of care, or initiate the order for home health services and “hand off” the patient to the community-based physician to review and sign off on the plan of care. In rural areas, the face-to-face encounter can occur via a telehealth conference at an approved originating site.
Additional information about these requirements is provided at the Medicare Learning Website at: http://www.cms.gov/MLNGenInfo.
If you have any questions pertaining to the face-to-face encounter home health certification requirements, please contact Barbara Stegun Phair, Esq. at (516) 328-2300, extension 108, or your attorney contact in our firm.
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Abrams, Fensterman, Fensterman, Eisman,
Formato, Ferrara & Einiger, LLP
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