According to a new report by the Department of Health and Human Services Office of the Inspector General, Medicare is paying billions of dollars to home health providers without adequate documentation of patients’ needs by doctors. Because the cost of caring for homebound patients is increasing, the government is trying to gain better control by requiring doctors to certify Medicare beneficiaries’ eligibility for home health services with face to face (F2F) examinations. The OIG has estimated that $2 billion in inappropriate payments were made between 2011 and 2012 due to inadequate compliance with the rule. Home health agencies, on the other hand, believe the F2F rule to be burdensome and vague, and that it only impedes their ability to deliver care.
OIG assessments have found that up to 32 percent of the claims that required F2F encounters did not meet the CMS criteria. Home health providers state that incomplete paperwork is not always an indicator of fraud or unnecessary services. They believe physicians sometimes fall short of the paperwork because they do not get paid to certify the F2F encounters, nor do they have contracts with agencies to coordinate patient care.
The OIG recommends CMS develop better strategies to improve compliance with the F2F requirement.
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