If the face-to-face encounter documentation and the CMS-485 form collectively satisfy all of the certification and plan of care content requirements as defined in Chapter 7 Section 30 of the BPM, Medicare contractors shall accept a CMS-485 form signed by the community physician who assumes oversight of the patient’s home healthcare with an addendum containing the face-to-face encounter documentation requirements signed by a physician who cared for the patient in an acute or post-acute setting, to satisfy the certification, face-to-face encounter, and plan of care requirements.
Full Answer
What is a face-to-face encounter for Medicare home health services?
•In addition to allowing NPPs to conduct the face -to-face encounter, Medicare allows a physician who attended to the patient in an acute or post -acute setting, but does not follow patient in the community (such as a hospitalist) to certify the need for home health ... the physician signs, or a signed addendum to the certification. It may be ...
What medical records are required for a face to face encounter?
Nov 08, 2016 · November 8, 2016. As a condition of payment for Medicare home health benefits, a physician must certify that a patient is confined to the home, needs skilled services, receiving the services under a plan of care established and periodically reviewed by a physician, and under the care of the physician. [1] The Affordable Care Act (ACA) added a requirement that prior to …
When did the face to face encounter become required for home health?
Medicare Face-to-Face Requirements For certain specified items of durable medical equipment, the Affordable Care Act requires: An in-person, face-to-face examination with the treating practitioner (Medical Doctor (MD), Doctor of Osteopathic Medicine (DO) or Doctor of Podiatric Medicine (DPM), physician assistant (PA), nurse practitioner (NP) or clinical nurse specialist …
How is a patient certified for the Medicare home health benefit?
The Affordable Care Act (ACA) established a face-to-face encounter requirement for certification of eligibility for Medicare home health services, by requiring the certifying physician to document that he or she, or a non-physician practitioner working with the physician, has seen the patient. The encounter must occur within the 90 days prior ...
What is the Medicare home health face to face requirement and what is the purpose of it?
How does CMS define a face to face encounter?
What is required for a face to face?
What is a 485 in healthcare?
How long is F2F good for?
What is a face to face encounter in an office between the physician and patient?
What are face to face notes?
What is a face to face sheet?
Is a plan of care the same as 485?
What is a resumption of care?
What is the CPT code for home health certification?
Some private payers may cover similar services using these codes; others may consider them to be part of care plan oversight, which is billed with CPT codes 99374-99375.
What is a condition of payment for Medicare home health benefits?
As a condition of payment for Medicare home health benefits, a physician must certify that a patient is confined to the home, needs skilled services, receiving the services under a plan of care established and periodically reviewed by a physician, and under the care of the physician. [1] The Affordable Care Act (ACA) added a requirement that prior to such certification the physician must document that the patient had a face-to-face encounter with an allowed physician or non-physician practitioner (NPP) within a reasonable timeframe as established by the Secretary of the U.S. Department of Health and Human Services. [2]
How often do you have to recertify for home health?
After an initial home health episode, recertification of the need for continued home care must be provided at least every 60 days, and must be signed and dated by the physician who reviews the plan of care. [13] . Medicare does not limit the number of continuous episodes for patients who continue to be eligible for the home health benefit.
What is F2F encounter?
A F2F encounter may occur by tele-health as provided in §1834 (m) of the Social Security Act. [5] If the patient did not have a F2F encounter prior to admission, or had an encounter that was not related to the main reason the patient requires home health services, the patient would need to have a qualifying F2F encounter sometime during ...
What is an NPP?
An allowed non-physician practitioner (NPP) working in collaboration with or under the supervision of the certifying or facility physician may also perform the encounter. Allowed NPPs include a Nurse Practitioner, Clinical Nurse Specialist, Certified Nurse-Midwife, and Physician Assistant. The encounter cannot be performed by any physician ...
Time Frame for the Encounter
The FTF encounter must occur within 90 days prior to the Start of Care (SOC) or 30 days after the SOC. The FTF documentation must show the FTF encounter occurred within this timeframe.
Who Performs and Signs the FTF Encounter
The FTF encounter must be performed by the certifying physician, a physician who cared for the patient in an acute or post-acute facility directly prior to being admitted to home health, and who had privileges at the facility, or a qualified non-physician practitioner (NPP) working in conjunction with the certifying physician.
FTF Documentation
As of January 1, 2015, documentation in the certifying physician's medical records and/or the acute /post-acute care facility's medical records (if the patient was directly admitted to home health) will be used as the basis upon which patient eligibility for the Medicare home health benefit will be determined.
Billing Responsibilities
As the billing entity, it is the responsibility of the home health agency to:
How long does it take for a home health encounter to be billed?
A: The encounter must occur no more than 90 days prior to the home health start of care date or within 30 days after the start of care. If a patient does not receive face to face encounter by day 30, coverage requirements are not met and episode cannot be billed.
Can home health insurance be paid for home health?
A: Under both the hospital insurance and the supplementary medical insurance programs, no payment can be made for covered home health services that a home health agency provides unless a physician certifies that:
Consolidated DMEPOS Lists
The Master List (PDF) is a library of all DMEPOS items posing vulnerabilities to the Trust Fund that may require providers/suppliers to comply with additional conditions related to payment requirements. From this list, items may be selected for one or both of the Required Lists:
Required Face-to-Face Encounter and Written Order Prior to Delivery List
Review contractors assess compliance with the face-to-face encounter and written order prior to delivery requirements. Some items (such as PMDs) have statutorily imposed requirements.
Written Order Prior to Delivery (WOPD) Requirements
For items on the Required Face-to-Face Encounter and Written Order Prior to Delivery List, a complete order is required prior to the item’s delivery.
Face-to-Face Encounter requirements applicable to certain DMEPOS items
For all items requiring a face-to-face encounter, a practitioner visit is required within six months preceding the order. Note: face-to-face encounters for PMDs were previously required within 45 days preceding the written order.
Learn More
DMEPOS Written Order, Face-to-Face Encounter, and/or Prior Authorization Requirements (PDF): Learn more about the standard elements for a DMEPOS order and items potentially subject to face-to-face encounter and written order prior to delivery and/or prior authorization requirements.