Starting January 1,2011 physicians must see and examine a patient when ordering Medicare covered home health care services. This is a condition of the health reform act (Affordable Care Act) passed in the spring of 2010. Prior to certifying the patient's order for HH services, the physician must document that he or she or a collaborating Non-Physician Practitioner had a face-to-face encounter with the patient. The NPP's who are allowed to perform this certification are Nurse Practitioners, Physician Assistants, Clinical Nurse Specialists and Certified Nurse Midwives.
For care that begins Jan 1, 2011, there must be documentation that a face-to-face encounter occurred within 90 days prior to the start of care or within 30 days after the start of care.
The clinician must document how the patient's clinical condition supports homebound status and the need for skilled care.
If the patient's status changes, and the physician or NPP has not seen the patient in the past 90 days, the clinician may order home health care, but a visit within 30 days of the start of the care is required.
Medicare does allow the hospitalist or other physician in the acute care setting to certify the plan of care, and then hand off the order to the community based physician.
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