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May 27, 2016

Home Health Face-to-Face Documentation

Based on the most recent Comprehensive Error Rate Testing (CERT) error report, CGS continues to see errors where the physician's face-to-face (FTF) documentation does not support the patient's homebound status and/or medical necessity. Please review the following information to help reduce these types of errors.

  • Documentation in the certifying physician's medical records and/or the acute/post-acute care facility's medical records is used to determine the patient's eligibility for Medicare home health care.
  • To be eligible, a physician must certify that the patient meets the following requirements:
    • Confined to the home;
    • Under the care of a physician
    • Services are provided under a plan of care established and periodically reviewed by a physician;
    • Be in need of skilled nursing care on an intermittent basis or physical therapy or speech-language pathology; or
    • Have a continuing need for occupational therapy.

Although the home heath agencies (HHAs) documentation is not used to demonstrate the patient's eligibility, the HHAs documentation can be incorporated into the certifying physician's medical record and used to help support the patient's homebound status and need for skilled care. HHAs are encouraged to send documentation to the physician at the same time the certification is sent to be signed. Such HHA documentation may include, the admission summary, part of the Outcome and Assessment Information Set (OASIS), therapy evaluation or therapy notes, and nurse's notes. This information must be corroborated by other medical record entries in the certifying physician's medical record. The certifying physician must sign off on the HHAs documentation, prior to submitting the claim.

Refer to the resources below for additional information:

Please share this information with your appropriate staff.

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