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Mandatory Reading


Every day I work to help my clients provide better care at lower costs so that we can all make a decent living.   I have no issue with making money in healthcare.  In fact, I am proud to get paid for work that ultimately helps patients.  There is no law against making money.  That is not to say that there aren’t any laws that affect us.  If it has not come to your attention that healthcare is a highly regulated industry, then you are probably not reading this.  Finding the on/off button on the computer would require more observation skills than you have.

Just to be clear, let me clarify the following regarding Physician Face to Face Encounters in Home Health.

  1. The physician must write his or her own narrative.  Alternatively, he may dictate it and his staff may type it.  A qualified NPP may perform and document the encounter but the certifying physician must sign beside the NPP.  Make no mistake, you are not a qualified NPP.
  2. The Face to Face encounter is a condition of payment.  Failure to follow the conditions of payment may result in credible allegations of fraud.  Fraud may result in large financial penalties or jail and a great deal of embarrassment.
  3. The encounter must occur within 90 days prior to admission or within 30 days post admission.  This does not mean that you are committing fraud if the signed F2F is not on the chart within 30 days post admission.  If you sent the form out with the initial plan of care that went out late, it is very possible that the F2F will not be on the chart at day 30.
  4. On the other hand, if a patient was NOT seen within the time frame, you should discharge the patient using the appropriate documentation (ABN) and let the patient know why.  Be very certain that the patient was in fact seen by the MD if you choose to wait for it.  Alternatively, you could get your careplans out on time.
  5. When my clients’ referral sources steer their referrals to the agencies that don’t make them worry about ‘all the bureaucratic paperwork bulls***’, a competitive edge is created against which ethical agencies cannot compete.
  6. If a physician signs said bureaucratic paperwork and a visit had not been made, you have found yourself an accomplice in fraud.  Understand this.  The Feds want you more than the doc because even the wealthiest docs don’t bill as much as a home health agency does and it is not a condition of payment for MDs.
  7. The right FBI agent will not disclose that to the doctor.  Instead, the FBI will convince the MD that capital punishment is a very real possibility unless he or she rats you out.  Consider that referral source who will sign anything you put in front of him or her a potential witness in your next fraud case.
  8. If being morally superior is not enough incentive for you to follow the rules, then consider that while most people get away with it, some do not.  Those who do not will readily tell you that it is a good idea to follow the rules before you attract the attention of the Feds.
  9. If being morally superior is not enough and you are willing to take the chance of being on a federal radar, there is always the possibility that I personally will find out who you are.  If that happens, you will wish  you were caught by the FBI because I am not nearly so nice.  Ask Bill Borne.
  10. Don’t mess with my clients.  They are trying to survive by doing the right thing.

Chances are the people who circumvent the rules to make life easier for physicians and steer referrals away from your agency will never get caught. That’s the truth. Nobody has a policy or talks openly about it. Instead, bonuses and positions are contingent upon the amount of claims billed and so a real incentive to take shortcuts presents itself and pleading ignorance is a valid option.  If a visit was made on the day documented on the F2F, it would be very difficult to prove that the MD didn’t write the narrative.  So that leaves agencies with the choice of doing something that violates the conditions of payment and probably never getting caught or losing referrals.  Are you starting to get why my mood has gone south?

I help a lot of people who have done things resulting in the appearance of fraud.  I help people who have actually submitted fraudulent claims.  I have not ever nor will I ever help anybody submit a fraudulent claim.  I would like to tell you that it is because I am morally superior but the truth is, it just isn’t necessary to take even the smallest risk.  Sick people will always be around and their will always be ways for us to improve care.  In fact, if we did all that we were capable of, CMS and Congress would be at our doors asking us how we wanted our money – direct deposit or cashier’s check.

Do the right thing, y’all.  I don’t like being angry.  And remember, it is all about me.

4 Comments Post a comment
  1. Dwelia Boyce #

    It is amazing how you always seem to speak to the dilemma I am in, but I still want to ask you this question so that I can cover my license and have documentation that what I was told was far from the truth. It is ok for a Clinical Supervisor to put sticky notes on the f2f to tell the physician why they sent the patient to homecare. When I was told to do it, I was also told they checked with Medicare and they said it was ok

    Like

    May 4, 2012
    • Okay, now that is tricky. Can you discuss with the MD and remind him of the events that went on prior to home health? I, frankly, do not see a problem with that per se. So, it could also be in writing. Where I get confused is when I consider that the F2F documentation is supposed to a record of his visit with the patient. Were you there?

      The MD’s actually may need a little help. I am not sure that I like the sticky note procedure though. It is too close to preparing the documentation for him. However, docs will write stuff like patient is homebound because they don’t go anywhere and they need home health to prevent hospitalizations.

      Maybe a better suggestion would be to write a single sheet of paper with instructions on how to fill out the form and then on that same sheet give examples. So, if I give examples of homebound that include language describing functional limitations and shortness of breath and psychiatric status and he is the one who writes the information for the patient, that shouldn’t be an issue. If your careplan is coded correctly, he should have a document right there that states the primary diagnosis and you could even include a copy of your referral sheet.

      One of the biggest problems I see is that the MD’s often don’t know what we are doing. Isn’t that funny? Seriously, they will write that the patient requires home health because of one reason and we will actually see the patient for another reason. A patient may have a long standing dx of Alzheimer’s disease and so they need help with wound care. The doc thinks we are seeing the patient for AD but really the skill is wound care. Depending on how picky the reviewer is, it really does make a difference.

      Furthermore, the doc could say, ‘see attached’ and attach a hospital discharge summary if it included all the necessary components. There is no law that says a particular form must be used.

      I am so impressed that you have a doc who is even willing to participate in the process. That’s how low my standards have dropped when it comes to face to face encounters:)

      Like

      May 4, 2012
  2. Libby Werchan #

    Amen!!!! That’s all I have say

    Like

    May 4, 2012
  3. RM #

    When our patient has a 30 day and we send the F2F form to the Doc and do not receive it signed within the 30 days (even though the encounter happended timely) we have been discharging and not billing. once we have the form signed we then readmit. Reading what you wrote above it seems that as long as the encounter happended within the 30 days we are OK if the MD takes longer than 30 days to sign the F2F? Can you clarify that for me.

    Like

    May 7, 2012

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