Medicare’s contractors are expanding their respective post-payment reviews of claims as industry concerns about Medicare’s home health face-to-face physician encounter requirements continue to rise. The NAHC Board of Directors have already approved the filing of a lawsuit challenging the requirement that physicians provide sufficient narratives on a patient’s homebound status and need for skilled care. NAHC says the lawsuit is “ready to go” and has the intention of filing it in Federal District Court in Washington, D.C.
CMS has expressed a willingness to consider a resolution of the industry’s concerns without litigation. A meeting scheduled for May 8 will determine whether more discussions and negotiations are needed or whether the lawsuit should be filed immediately. During this time, NAHC recommends that home health agencies “continue to strive for compliance with the difficult face-to-face encounter documentation rules” and that “agencies preserve their rights to payment by filing administrative appeals on any questionable claim denials.”
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