The Affordable Care Act (aka: Obamacare) has created a rule that is blocking patients’ that qualify for home health care services from getting the medical help they need. In what the creators of the ACA are touting as a rule created to combat fraud, they have effectively created a rule that is limiting Medicare Recipients’ access to home health care services. The ACA’s rule is called the Face-to-Face Encounter.
In order to receive home health care services, Medicare requires that recipients must be “homebound” and in need of home health services that are “Skilled Services.” According to Medicare, homebound means: 1) Leaving your home isn’t recommended because of your condition; 2) Your condition keeps you from leaving home without help; 3) Leaving home takes a considerable and taxing effort. According to Medicare, Skilled Services are defined as: 1) Intermittent Skilled Nursing, 2) Physical Therapy, 3) Speech-language Pathology, or 4) Continued Occupational Therapy.
The Face-to-Face Encounter is a document that home health care providers are required to get from the Physician that is certifying the home health care services. The patient must have an office visit with the Physician for the Physician to determine if the patient is homebound and why they require skilled services. According to the ACA the Physician must document on the face-to-face encounter a brief narrative that describes how the patient’s clinical condition as seen during that encounter supports the patient’s homebound status and need for skilled services. The Physician must also sign, title, and date the document.
Seems clear and simple, right? Wrong! Why, you ask? There are many reasons. The ACA never created a standardized Face-to-Face Encounter documentation form. So, everyone involved including home health care agencies, Physicians, Medicare contracted Auditors, and even Medicare itself have no idea what an actual Face-to-Face Encounter documentation is. Home health agencies and Physicians’ offices have created their own documents in attempts to meet the requirements, but each one is different.
Additionally, the ACA never defined what a “narrative” is. Again, all parties involved have different ideas about what a narrative is. Everyone is making an effort to meet the requirement, but no one actually knows what the requirement is.
Ultimately, home health agencies payments are being denied because Medicare Auditors are determining that Physicians are not completing the Face-to-Face Encounter documentation as required by Medicare. Yet, you can’t blame the Physicians because no one actually knows what is required. In an attempt to be diligent, home health agencies are requesting Physicians to redo face-to-face encounters in order to include as much information as possible. Yet, home health agencies have no way of requiring or enforcing that a Physician includes anything. There is no incentive or reprimand for a Physician to complete the face-to-face encounter documentation in any way. Does anyone need to be reminded that doctors are busy people!
In the grand scheme of things, Medicare Recipients are the ones who are suffering. Home health care agencies are unable to provide services to Medicare Recipients who are eligible and need home health care services. Home health care providers’ claims are being denied on the premise that since the face-to-face encounter form isn’t completed correctly according to a subjective review, the patient doesn’t meet the eligibility requirements for home health care services. Legitimate claims for legitimate home health care services are being denied, creating red tape between providers and patients. It’s great that the creators of the ACA are concerned about fraud, but the face-to-face encounter rule was very poorly thought out.
Links to other resources:
http://oig.hhs.gov/oei/reports/oei-01-12-00390.pdf
http://khn.org/news/incomplete-face-to-face-doctor-exams-put-home-health-agencies-in-tight-spot/
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