CMS Makes Late F2F Encounter Concessions

The Centers for Medicare & Medicaid Services (CMS) finalized its policy position on determining start of care dates for home health episodes of care in cases where a home health patient does not meet face-to-face (F2F) encounter requirements within 30 days of a start of care (SOC).

CMS’ response to an appeal for leniency as to how to handle episodes of care when a F2F encounter is late was published in the Nov. 4, 2011 Federal Register update of home health payment rates. The notice resolves confusion resulting from multiple conflicting statements from CMS over the past several months about late encounters, including those made during Open Door Forum calls and in the July 2011 CMS OCCB Q&As on OASIS.

The National Association for Home Care & Hospice (NAHC) appealed to CMS to allow home health agencies to amend episode SOC dates to a date 30 days prior to the F2F encounter date in cases where a late encounter occurred. NAHC reminded CMS that a precedent was set for waiving the requirement for completing OASIS assessment within 5 days of a SOC, which was the basis for its inflexibility, in the Medicare Claims Processing Manual Chapter 10 Section 80 Special Billing Situations Involving OASIS Assessments.

NAHC appealed to CMS to apply this policy to late F2F encounters as in the manual guidance for retroactive payer change. NAHC pointed out that, just as payer changes are not in their control of home health agencies, neither is compliance with F2F encounters within the control of the home health agency.

In the Federal Register notice, CMS agreed and explained that it was taking the opportunity to expand the policy as found in Section 80 that allows for flexibility of OASIS completion within 5 days of the SOC to late F2F encounters. CMS wrote:

“Specifically, where a face-to-face encounter did not occur within the 90 days prior to the start of care or within 30 days after the start of care, a provider may complete another OASIS with a start of care date equal to the date when all Medicare eligibility is met. However, Medicare will not pay for services provided before the date of eligibility.”

In subsequent conversations with CMS representatives, NAHC was told that Medicare manuals will be updated to reflect the addition of late F2F encounters to the targeted situations in which flexible OASIS timing is acceptable. In addition, Question 1 in the July 2011 Quarterly CMS OCCB Q&As will be rescinded and replaced with new guidance for meeting OASIS requirements if a start of care date is retrospectively changed to be within 30 days of a late F2F encounter.

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