General Surgery Coding Alert - 2010 Issue 19
Physician Reviews: Face-to-Face Rule Brings New Round of Physician Headaches for Those Who Certify Home Health
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Article Overview
This article explains proposed CMS requirements tied to physician certification of home health services under the 2011 home health prospective payment system. It covers the timing of the encounter, who may perform it, the documentation CMS expects, and the program-integrity concerns driving the proposal. The piece is relevant to physicians, qualifying non-physician practitioners, home health providers, and coders or compliance staff who track Medicare home health policy changes.
Why This Topic Matters
The proposal affects how home health eligibility is certified and documented, which can influence Medicare payment and compliance workflows. Readers who work with home health claims or physician certification processes need to understand the scope of the requirement and the documentation expectations described in the article.
What You Will Learn
- How CMS proposed to structure face-to-face encounter requirements for home health certification
- What types of practitioners are discussed in connection with the encounter requirement
- What documentation themes CMS expects physicians to include in the certification process
- How timing and changes in patient condition affect the proposed requirement
- Why CMS links the proposal to program integrity and Medicare payment eligibility
Who Should Read This
- Physicians
- Home health agencies
- Non-physician practitioners
- Medical coders
- Coding compliance staff
- Revenue cycle professionals
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