The Face-to-Face Encounter is a condition for payment for patients with Medicare fee-for-service & may not be required for patients with Medicare Advantage plans
Does Medicaid require face to face?
•The face -to-face encounter must occur within the 90 days prior to the start of home health care, or within the 30 days after the start of care •In situations when a physician orders home health care for the patient based on a new
How to get home health through Medicare?
Nov 08, 2016 · The intent of the Face to Face Encounter provision was to reduce fraud, waste, and abuse by assuring that physicians or other healthcare providers actually meet with potential home health patients to ascertain their specific care needs. 42 CFR § 424.22(a)(1)(v)(A); Medicare Benefits Policy Manual (MBPM) CMS Pub. 100-02, Ch. 7 § 30.5.1.1(1).
Is in home care covered by Medicare?
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 to the start of care, or within the …
Does Medicare pay for personal care services?
The Face-to-Face Encounter is a condition for payment for patients with Medicare fee-for-service & may not be required for patients with Medicare Advantage plans
What is required for a face to face?
The certifying physician's face-to-face description should be a brief narrative describing the patient's clinical condition and how the patient's condition supports homebound status and the need for skilled services.
When should the face to face encounter occur?
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.
Who can perform face to face encounters?
Five roles can perform Face-to-Face encounters:The certifying physician.A physician, with privileges, who cared for the patient in an acute or post-acute care facility from which the patient was directly admitted to home health.More items...•May 10, 2017
Are telehealth visits considered face to face?
Telehealth can count as a face-to-face encounter under certain conditions. Medicare rules allow the face-to-face encounter to be performed through a telehealth service in some cases as long as the beneficiary is in a rural health professional shortage area or in a county outside a metropolitan statistical area.
Does Medicare cover non face to face services?
Non-Face-to-Face Codes Are Now Billable Medicare now acknowledges this.
Why are face to face encounters important?
The intent of the Face to Face Encounter provision was to reduce fraud, waste, and abuse by assuring that physicians or other healthcare providers actually meet with potential home health patients to ascertain their specific care needs.Nov 8, 2016
Is a discharge summary face to face?
Discharge summaries are not always useful in noting the physician's required face-to-face encounter with the patient. Simply state, “Patient seen and examined by me on discharge day.” Alternatively, hospitalists can elect to include details of a discharge day exam.May 2, 2010
What is included in a clinical summary?
Clinical Summary – An after-visit summary that provides a patient with relevant and actionable information and instructions containing the patient name, provider's office contact information, date and location of visit, an updated medication list, updated vitals, reason(s) for visit, procedures and other instructions ...
What is a face to face sheet?
A face sheet is a document that gives a patient's information at a quick glance. Face sheets can include contact details, a brief medical history and the patient's level of functioning, along with patient preferences and wishes.
Is a phone call considered telehealth?
Generally, telemedicine is not an audio-only, telephone conversation, e-mail/instant messaging conversation, or fax.
What is the CPT code for a virtual visit?
For these E-Visits, the patient must generate the initial inquiry and communications can occur over a 7-day period. The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G2063, as applicable. The patient must verbally consent to receive virtual check-in services.Mar 17, 2020
Can Medicare annual wellness visits be done via telehealth?
During the pandemic, Medicare is reimbursing telehealth AWVs at the same rate as it would if the visit were completed in person. You can see a full list of the services Medicare is allowing via telehealth on the CMS websiteopen_in_new.Sep 30, 2020
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 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 ...
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 ...
Does Medicare require face to face encounter?
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-physi cian practitioner working with the physician, has seen the patient.
Is home health certification required?
The regulation has been fully implemented and providers are complying with the requirements. Certification for home health is already required by physicians. The face-to-face encounter for home health care can be included in the certification documentation or on a separate form.
What is the FTF encounter?
The FTF encounter must be related to the primary reason for the home care admission. This requirement is a condition of payment. Without a complete initial certification, there cannot be subsequent episodes. Claims may be denied if the FTF documentation is not complete.
How long does it take for a FTF to occur?
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.
How long does a F2F encounter need to be performed?
As described in 42 CFR 424.22, the F2F encounter must be related to the primary reason the patient requires home health services and must be performed no more than 90 days prior to the home health start of care date or within 30 days after the start of the home health care. A F2F encounter must be performed by the certifying physician, a physician (with privileges) who cared for the patient in an acute or post-acute care facility from which the patient was directly admitted to home health, or allowed Non-Physician Practitioner (NPP)1 who does not have a financial relationship with the Home Health Agency (HHA) (unless the financial relationship meets one of the exceptions set forth in §411.355 through §411.357 of the Act).
Can HHA information be incorporated into a medical record?
Information from the HHA may be incorporated into the certifying physician’s and/or the acute/post-acute care facility’s medical record regarding the patient for whom the home health services are ordered/certified. When considering incorporation of information from the HHA the following are expected and required:
