MLN Clarification

Jennifer Barker, a dear friend and the administrator at Audubon Home Health knows me well.  She gets that I do not open emails without a compelling reason to do so and she made sure her I opened hers today.  The subject line was:  WTH?!?  If there had been even one more exclamation point, I suspect the email would have opened itself.

Her concern was with the most recent MLN guidance for the Face-to-Face document which was updated with examples on January 15, 2014.  I read it briefly and did not fully understand her concern until I went back to her email.

Before I tell you Jen’s concerns, go look at page 10 and 11 of the MLN guidance. 

Did you see it? 

Jen pointed out that apparently MLN matters doesn’t realize that home health agencies type up the plan of care.  In MLN’s defense, there is a line that states that MD ‘documents’ the face to face encounter on the plan of care but since there is no change in font or color, it appears as though the encounter documentation is part of the original information sent to the MD for signature.

WARNING:  YOU – AS A HOME HEALTH AGENCY OR HOME HEALTH AGENCY EMPLOYEE – MAY NOT CONTRIBUTE TO THE DOCUMENTATION REQUIREMENTS OF THE FACE-TO-FACE ENCOUNTER.

So, I started looking some more.  The MLN matters document mentions a couple of times about the MD dating the signature of the face to face documentation.  Did that change?  Why on page eleven is it necessary for the MD to sign twice?  I’m just curious.  The Medicare Benefit Manual, chapter 7 pertaining to home health states:

The certifying physician must document the encounter either on the certification, which the physician signs and dates, or a signed addendum to the certification. It may be written or typed.

There is certainly nothing at all wrong with a dated signature and by far, two signatures are better than none.  However, do not be misled into thinking that your face-to-face documentation is incorrect if your:

1. Face-to-face encounter is documented on the plan of care which is signed and dated by the physician (in which case only one signature is required and that signature is dated)
2. An addendum is attached to the plan of care documenting the the face-to-face encounter which is signed by the physician (a date is not incorrect but is not mandated according to the Benefit Manual).

The note on page 2 of the MLN matters information may contradict the manual although due to the sentence structure, I am not sure what the note actually means.  It reads:

Note: The homebound status of the patient and his/her need for skilled services must be written in a brief narrative, signed by the physician, titled “Home Health Face to Face Encounter”, and dated.  (Exactly what must be dated in that statement?)

Remember, these are the instructions that your referring physicians are receiving.  There is no point in contradicting them as a date will not invalidate the face-to-face documentation.  However, I do not suggest going back for a revision if a face to face encounter document does not have a dated signature.

Hey, I have an idea…..  Let’s focus on taking care of patients next week.  Any ideas of how we can help each other become better nurses?