LeadingAge Tells Congress to Eliminate Required Physician Face-to-Face Documentation

Legislation | August 28, 2017 | by

The home health face-to-face physician encounter documentation requirement should be eliminated and other fraud and abuse measures adopted.

For Medicare to cover a beneficiary's home health care, the certifying physician must document a face-to-face encounter with the patient on the initial episode. If the certifying physician does not complete the face-to-face requirement documentation correctly, Medicare coverage of the entire episode can be denied.

The regulation aims to ensure physician oversight of home health, but Medicare already requires a physician referral and orders, and a signed physician plan of care. The additional and unnecessary paperwork requirement adds to the administrative costs of the home health agency and certifying physician and does not improve the quality of care for the patient. Instead, home health agencies have increased the number of staff to check documentation compliance, and address the substantial upsurge in home health claim denials and the backlog of appeals.

A bipartisan group of seventy‐five members of Congress stated that the “complicated, confusing and overlapping documentation requirements … exceed the intent of the law passed by Congress.” Although the home health face-to-face physician encounter documentation requirement has been in effect for several years, there are no indications that it has succeeded in reducing Medicare fraud. 

Related Statute/Regulation:

The face-to-face requirement is a condition of payment under Section 6407 of the Affordable Care Act (ACA).  P.L. 111-148, § 6407(a), as revised by § 10605 (adding the face-to-face requirement at Social Security Act, § 1814(a)(2)(C)).

Proposed Solution:

  1. Develop a targeted approach to combat inappropriate billing practices that focuses on providers that appear to be billing for aberrant patterns of home health utilization, not an approach that cast the regulatory burden on providers that are complying with eligibility and billing regulations.
  2. Discontinue the Home Health Face to Face Physician Encounter Documentation Requirement