16 State Coalition Releases Q&A With Palmetto GBA: Seeks More Answers on Face2Face

The 16 State Coalition, comprised of executive directors from the 16 home care state associations in Palmetto GBA’s Jurisdiction 11 (including HCAF’s Bobby Lolley) have released the results of their quarterly Q&A session with Palmetto GBA executives.

Each quarter, the 16 State Coalition sends questions to Palmetto GBA that come from state association members in an attempt to get a more direct answer on some of the applications of the regulations Palmetto GBA oversees. P-GBA reviews the questions and sends answers to the Coalition, which is then followed by an in-person meeting between the coalition and Palmetto GBA.

The questions and answers can be found here. Of note, Palmetto GBA answered most questions on Face-2-Face documentation by referring the Coalition to the Medicare Beneficiary Manual as well as CMS’s 60 page FAQ on Face2Face.

Dissatisfied with these answers, the Coalition sought to learn more at the in-person meeting. At the meeting, Palmetto GBA’s medical director explained to the state directors that Palmetto would seek to change the way in which they have been reviewing Face2Face documentation. Going forward, Palmetto plans to implement changes that would have them look at all of a patient’s documentation versus denying based only on Face2Face, as well as give providers a specific reason when issuing a denial of a claim.

As part of their efforts to make changes to the review process, Palmetto requested examples of Face2Face denials in which providers felt the claim should have been paid. They will be reviewing these examples into December and it is the coalition’s hope that changes to the review process will be made by early 2014.

HCAF will keep our members updated as this incredibly important issue develops.


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