NAHC receives many responses on face-to-face requirements

This is a brief from NAHC regarding the April 1 enforcement date on face-to-face encounters. I’ll keep you informed on more as I know it …

The implementation of the Medicare face-to-face encounter rules in home health services and hospice continues within the provider, physician, and beneficiary communities as the “dry run” opportunity before the April 1 enforcement date approaches its end (NAHC Report, 1/5/11). The National Association for Home Care & Hospice (NAHC) and a large contingent of supportive stakeholders are continuing their advocacy with the Centers for Medicare & Medicaid Services (CMS) in an attempt to get the rules applied in a sensible and understandable manner. On Monday, NAHC and the other stakeholders engaged CMS via teleconference to review progress on the face-to-face encounters to date, outline unresolved issues, propose further adjustments, and establish remaining action steps for both CMS and stakeholders this month before enforcement is set to begin.

The discussions with CMS involve a deep and dynamic coalition of provider and beneficiary representatives including AARP, the American Medical Association, and the American Hospital Association. Numerous other physician, hospital, case manager, and beneficiary groups are also part of the effort.

The teleconference earlier this week addressed both hospice and home health matters related to the face-to-face encounter requirements. CMS has now released guidance on two crucial hospice issues: (1) the timing requirement for the hospice physician encounter for patients admitted at the start of the third benefit period, and (2) whether the encounter physician must be the same as the terminal illness certifying physician (NAHC Report, 3/2/11).

A number of unresolved home health issues remain, including the nature of the physician documentation required. CMS was presented with a long list of pending questions that need answers or clarification.

A significant focus of the meeting was the results of the ongoing survey that NAHC has conducted since late last week. Home health agencies have responded in unprecedented numbers — to date, NAHC has received over 3,300 survey responses. The information provided is crucial to the efforts to address concerns about the rule, and NAHC thanks all who have provided their input.

A detailed survey report is being developed. However, a preliminary review of the data shows that:

  • Virtually all home health agencies are engaged in serious efforts to educate their staff as well as physicians and patient referral sources both with written materials and in person;
  • There is still an incomplete understanding of the requirements and significant confusion in the physician community, with over two-thirds of agencies reporting that physicians remain confused;
  • Despite the intensive educational efforts of home health agencies and CMS, 66 percent of respondents indicate that physician understanding has not improved and nearly 20 percent report that it has gotten worse;
  • Among the most alarming survey results, 47 percent of agencies report that they deal with physicians who intend to refer patients to other care settings instead of home care because of the face-to-face encounter requirements. Over 35 percent of agencies report that some physicians have indicated that they will refuse to provide the required documentation;
  • The most prevalent concern with physicians is the documentation requirements. Respondents recommend allowing the use of checkboxes (83 percent); eliminating the narrative on homebound status and medical necessity (77 percent); and allowing physicians to use other documents that include the needed information (72 percent); and
  • The survey also indicates that one-third of agencies expect to refuse admission to patients who have not had a qualifying encounter prior to admission, while 80 percent plan to terminate care to those who do not have the qualifying encounter within the 30-day window.

In response to these survey findings, CMS officials asked what more they could do to bring about compliance by April 1. The various responses offered by stakeholders included providing more time before enforcement begins and being more flexible on the documentation requirements.

An additional discussion with CMS is in the process of scheduling for mid-March. NAHC continues to recommend that home health agencies and hospices take advantage of this transition period to test what is working and what is not with respect to the requirements. At this point, the likelihood of sufficient compliance capability by April 1 is in serious doubt. Providers experiencing problems with the face-to-face encounters should continue to report these issues to NAHC. In addition, providers should encourage any physicians with concerns to convey them to CMS directly or through their associations/medical societies.

NAHC is continuing to compile results from the survey received through yesterday and will publish a full report in an upcoming issue of NAHC Report.


Note from Lisa: The links to the NAHC newsletter won’t work here because they are password protected, but I will get the hospice and other information posted soon.

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