Physician Face-to-Face Encounter Requirement

Source: Federal Register/Vol. 76, No. 214/Friday, November 4, 2011/Rules and Regulations

F. Home Health Face-to Face Encounter

Background

The Affordable Care Act established the requirement for a physician face-to-face encounter prior to certifying a patient’s eligibility for the Medicare home health benefit. The intent of the rule is:

  1. Address concerns of ineligible patients receiving home health care
  2. Limit home heath certification by physicians with no firsthand knowledge of a patient’s clinical condition
  3. Reduce re-hospitalization through increased physician participation in care

Requirement effective 1/1/11

As a condition of payment, prior to certifying a patient’s eligibility for the home health benefit, the physician must document that the physician himself or herself or a permitted non physician practitioner(NPP) has had a face-to face encounter with the patient.

Note: physician must document. Statute allows the certifying physician the following flexibility when completing documentation:

  1. An NPP can complete the encounter,and communicate clinical findings to the certifying physician who then incorporates information from the NPP into the physician face-to-face documentation.
  2. The physician may extract documentation from his/her own medical record to complete the face-to-face documentation.
  3. The certifying physicians support staff may extract documentation from the physician’s own medical record entries for the physician signature.

Revisions/clarifications effective 1/1/12

  1. Included language in the statute to allow for the physician who cared for a patient in an acute or post-acute facility to inform the certifying physician of a patient’s need for skilled services and homebound status in the same manner as a NPP can. The certifying physician can complete the face-to-face documentation based on the inpatient physician’s written or verbal communication.
  2. Clarified language to state the physician who cared for the patient in the acute or post-acute facility performing the face to face encounter must communicate the clinical findings to the certifying physician, unless the physician who cared for the patient in the acute or post-acute facility is also the certifying physician.

Physicians who cannot complete the face-to-face encounter:

  1. Partners or colleagues of the certifying physician
  2. Urgent care center physicians for non-acute patients
  3. Alternate physicians in an outpatient clinic

Home Health agencies:

  1. Cannot draft documentation for the certifying physicians to sign
  2. May facilitate communication between a physician in an acute or post-acute setting and the physician certifying eligibility for home health.