Question

In this assignment please provide short answers in your own words regarding this case study.

BACKGROUND

The Patient Protection and Affordable Care Act (ACA) requires that physicians (or certain practitioners working with them) who certify beneficiaries as eligible for Medicare home health services document—as a condition of payment for home health services—that face-to-face encounters with those beneficiaries occurred. This study (1) determined the extent to which physicians who certified home health care documented the face-to-face encounters, (2) described the nature of face-to-face documentation, and (3) assessed the Centers for Medicare and Medicaid Services’ (CMS) oversight of the face-to-face requirement.

HOW WE DID THIS STUDY

We reviewed 644 face-to-face encounter documents to analyze the extent to which the documents confirmed encounters and contained the required elements. We interviewed the four Home Health and Hospice Medicare Administrative Contractors (HH MACs) to describe how they ensure that home health agencies met the face-to-face encounter requirements. We also reviewed guidance documents and policies from CMS or the HH MACs about monitoring the face-to-face requirement.

WHAT WE FOUND

For 32 percent of home health claims that required face-to-face encounters, the documentation did not meet Medicare requirements, resulting in $2 billion in payments that should not have been made. Furthermore, physicians inconsistently completed the narrative portion of the face-to-face documentation. Some face-to-face documents provide information that, although not required by Medicare, could be useful, such as a printed name for the physician and a list of the home health services needed. CMS oversight of the face-to-face requirement is minimal.

Source: United States Department of Health and Human Services. (2014). Limited compliance with Medicare’s home health face-to-face documentation requirements. Retrieved from http://oig.hhs.gov/oei/reports/oei-01-12-00390.asp (Links to

Question: What should CMS do to ensure that all patients that need a face-to-face encounter receive one? You should be able to arrive at 3 different solutions to combat this issue.

Answer 1

The CMS can do some of the basic changes to ensure that all patients receive a face to face encounter

• The first visit of a patient to physician should be made face to face and it should be compulsory
• The incentives can be provided to physician who make face to face medical services
• Deducting service charge for the physician who fail to make facevto face interaction
• Providing a good quality health information technologies to perform virtual visits
• After telemedicine a face to face interview to be conducted