Many thanks to Tom Calhoun of Bayou Home Care for forwarding me the CMS update regarding proposed Medicare changes to the PPS system while I was out and about yesterday afternoon. (Be sure to click on the link and watch the video on Bayou Home Care’s page. You will understand why I am proud to be known a swamp rat).
Like everyone, I was excited to see CMS start to back off on the unclear, ambiguous and cumbersome requirements of the Face-to-Face requirement. The proposed changes are as follows:
- Eliminate the narrative requirement but the certifying physician would still have to document that a Face-to-Face visit occurred and include the date of the visit. Since nobody can agree on the definition of a ‘narrative’, this is probably a good thing.
- Medicare proposes the consideration of records from the certifying physician or discharge facility ONLY when determining eligibility.
- Physicians billing for certification/recertification for home health services will be denied if a patient is found to be ineligible.
The requirement that only the physician or discharge facility will mean that we can no longer turn to specialists records or pharmacy and other providers of care to support arguments of eligibility or homebound status. I’m not too worried but be very aware of this in the future should these changes come into law.
If you are interested in what your physicians bill for home health certification, check out Propublica’s Treatment Tracker and find your docs. Most do not bill often enough for certification/recertification visits to suffer appreciably from this requirement but some do.
All of this sounds really good, huh? It is – if you are an agency who has never been denied for providing good care to an eligible patient due to a poorly constructed Face-to-Face document.
Word of Caution
I tend to be overly sentimental and my first response to this update was an outpouring of warm feelings towards Medicare. Luckily, I forgot to post this last night and have had time to reconsider my emotional response.
The proposed regulations by Medicare, should they go into effect, will not address any denials that occurred prior to the changes. Recently, Palmetto sent a memo to y’all reminding you that no matter when a patient was admitted, the Face-to-Face documentation must be included with an ADR.
In other words, these changes offer no avenue of relief for denials that have occurred in the past. It also allows for limited denials related to the Face-to-Face document in the future if the start of care date occurred prior to the proposed changes.
The lawsuit filed by Bill Dombi, for NACH – your association – takes the position that the regulations written to satisfy the Face-to-Face requirement were never legal. If NAHC prevails in the lawsuit, then agencies may have recourse for prior denials if all other criteria were met.
I emailed Bill Dombi to determine if I was understanding this correctly and his response was that I appeared to be correct. That’s about all you will ever get from a lawyer without depositions, cataloged evidence, sworn statements and DNA – the appearance of being correct. In this case appearance does count.
So, welcome the changes. Rest comfortably knowing that there is a little gang in congress who are willing to relax the requirements implemented by the Grammar Police. This is a start – not the finish to the remediation of an unwarranted attack on home care for grammatical errors.
Under no circumstances, should you become complacent. The denials that occurred in the past were unfair and new rules taking effect at a future date will not change that. Similarly, don’t overlook the significance of the proposed regulations as it is appears that someone in Washington is listening.
Again, Thanks to Tom and to Mr. Dombi for taking time out of their days to keep me informed.