Our colleagues at Epstein Becker Green released a client alert: “Medicare’s Proposed Home Health Rule for 2015: CMS Suggests Only Limited Relief to the Face-to-Face Encounter Documentation Requirements but Continued Compliance Burdens on Home Health Agencies,” by Emily E. Bajcsi and Serra J. Schlanger.
Following is an excerpt:
On July 7, 2014, the Centers for Medicare & Medicaid Services (“CMS”) published proposed changes to the Medicare Home Health Prospective Payment System (“HH PPS”) for calendar year 2015 (“Proposed Rule”). The Proposed Rule would update the HH PPS payment rates effective January 1, 2015, including continued implementation of the rebasing adjustments as required by the Affordable Care Act (“ACA”). CMS projects that these proposed payment rate changes would result in overall payment reductions to home health agencies (“HHAs”) of $58 million, or 0.30 percent. CMS proposes a number of additional changes, including recalibration of the home health case-mix weights and changes to the home health quality reporting program requirements that would establish a minimum submission threshold for the percentage of OASIS assessments that an HHA must submit each reporting period. CMS is also asking for comments on a home health value-based purchasing model that it is considering testing in certain states beginning in 2016.
The Proposed Rule would also make significant changes to the physician face-to-face encounter requirements for HHA reimbursement. CMS claims that the changes would “simplify” the face-to-face encounter documentation requirements through elimination of the physician narrative requirement; however, CMS will expect the information formerly contained in the physician narrative to be documented in the medical record of the certifying physician or the discharging facility. To incentivize physicians to supply sufficient documentation, CMS proposes to deny the physician’s claim for certification or re-certification if the HHA claim is denied due to insufficient documentation to support beneficiary ineligibility. Yet, the Proposed Rule fails to provide any clarity as to what will constitute “sufficient” documentation. As a result, even with these proposed changes, HHAs will continue to bear both the risk of financial loss from denied claims and the burden of assuring that the certifying physician “sufficiently” documents the beneficiary’s eligibility to receive services under the Medicare home health benefit. Public comments to the Proposed Rule are due by September 2, 2014.