Medicare Learning Network Focuses on Face-to-Face Denials
Tuesday, March 11, 2014
by: VNAA Policy Team

Section: Quality and Educational Programming






Join VNAA in Las Vegas

Registration is now open for VNAA's 32nd Annual Meeting from April 1-4, 2014 at the beautiful Westin Lake Las Vegas Resort and Spa in Las Vegas. Annual Meeting is the year's largest gathering of executives, clinical experts and thought leaders from the fields of nonprofit home health and hospice.

Learn More


Get the Only Clinical Manual Your Agency Needs.

Designed specifically to help multidisciplinary home health and hospice professional teams improve their ability to deliver high-quality and consistent care in one adaptable and comprehensive evidence-based manual, the 18th edition of VNAA's Clinical Procedure Manual is one you won't want to miss.

Learn More


Follow the Pathway to Best Practices

VNAA introduces a new quality improvement and workforce training resource, the VNAA Blueprint for Excellence. It is a designed to provide information and tools for home health organizations, payers, policymakers, researchers and others with a stake in improving care transitions.

Available at no cost, the VNAA Blueprint includes research- and practice-based tools and training, as well as measurement and evaluation resources to guide home health care practices.

Learn More

A recent Medicare Learning Network Article, MLN Matters SE1405 provides guidance on how to avoid face-to-face denials. Documentation of the need for skilled care and homebound status is a key component to avoiding denials. The narrative, written by physician/non-physician practitioner or allowable staff, does not have to be lengthy but must include substantial clinical data that clearly identifies the need for a registered nurse or licensed therapist to provide needed services in the home.

Another common question related to face-to-face pertains to the definition and role of the certifying physician. CMS states "A physician must order Medicare home health services and must certify a patient's eligibility for the benefit." There is a common assumption that "the certifying physician" is the one signing the plan of care.  However, it could be a hospitalist or emergency room (ER) physician who could complete the face-to-face documentation and certify that the patient qualifies for home care. But the physician who signs the plan of care should be the one who will take responsibility for the patient throughout the 60-day episode.

The MLN article also provides examples of sufficient and insufficient narratives the physician's office could provide. To see these examples, click here.

Post a Comment

Name
Email
Comment