Medicare Compliance & Reimbursement - 2010 Issue 29
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 a CMS proposed rule affecting home health certification, with emphasis on encounter timing, who may perform the visit, and the documentation expected from the certifying clinician. It is relevant to physicians, qualifying non-physician practitioners, home health agencies, and coding/billing professionals who track Medicare home health payment policy and compliance guidance.
Why This Topic Matters
The proposed requirements affect whether home health episodes can qualify for Medicare payment, so they matter to clinicians, agency administrators, auditors, and revenue cycle staff responsible for compliance and documentation.
Article Sections
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Face-to-Face Encounter Requirement
Introduces the proposed CMS requirement for a clinician encounter tied to home health certification and outlines the general timing framework being discussed.
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Documentation and Certification Requirements
Covers the proposed documentation expectations for the certifying clinician, including how the encounter must be reflected in the certification record.
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Encounter Timeframe Narrows
Describes how the timing rule changes when the encounter was not for the primary reason for home care or when the patient’s condition changes significantly.
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Consequences
Summarizes the payment impact described in the article when the encounter requirements are not met.
What You Will Learn
- The scope of a proposed CMS home health certification requirement
- Which types of clinicians are discussed as eligible to perform the encounter
- How the timing of the encounter is described in the proposal
- What types of documentation are associated with the certification process
- What the article says about payment consequences when requirements are not met
Who Should Read This
- Physicians
- Non-physician practitioners
- Home health agencies
- Medical coders
- Billing and compliance staff
- Health information management professionals
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