WASHINGTON – A new face-to-face meeting requirement for home healthcare patients receiving Medicare has left some physicians and home healthcare groups disgruntled and industry experts shaking their heads at the idea that it will prevent fraud and waste.
On April 1, the Centers for Medicare and Medicaid Services implemented the Affordable Care Act's face-to-face encounter requirement. It had been postponed from a January start when providers voiced concerns that they wouldn't have time to establish operational protocols. CMS granted the postponement last winter but refused further postponement this spring.
The requirement of having physicians or non-physician practitioners (NPPs) meet with home healthcare Medicare patients was designed to prevent fraud, waste and abuse and encourage more patient-physician interaction. In addition to the face-to-face meeting, physicians and NPPs are required to provide supporting documentation.
"We don't see this as a very productive and constructive rule," said William Dombi, vice president of law at the National Association for Home Care and Hospice's Center for Health Care Law. "If it's out to get abusing providers, we anticipate that those are the ones who will have the easiest time with it. If they were going to do phony documentation before, they just have another set of phony documents to create."
"The providers who are trying to be compliant are having and will continue to have the greatest difficulty and expense in going after whatever documentation it takes to be compliant," he said. "Does this rule really control problems with any integrity of home care claims? We really don't see that. Does it encourage, from a clinical quality perspective, greater physician involvement? It seems it's encouraged physician resistance to using home care rather than an embrace of home care to get more involved with patients."
The face-to-face requirement does seem weak if its intent is to prevent fraud, said Wayne Miller, an attorney specializing in Medicare and insurance regulatory compliance matters at the California-based Compliance Law Group.
"I am concerned that it will have a very modest impact, if any," Miller said. "Doctors who already are diligent about seeing a patient before ordering home health services will do so whether they have to do this additional step or not. If this is intended to weed out criminal operations where doctor approvals are, for example, forged or identities stolen, it would seem possible for these operators to figure a way to 'game' this additional requirement."
The Center for Medicare Advocacy is taking a wait-and-see approach to the rule now that it's in force, said Alfred Chiplin, senior policy/managing attorney at the center.
He said he thinks there are good things about the rule, but implementation will be rough, and there are concerns beneficiaries will get hurt in the fallout.
"You start off with something that sounds so simple, so straightforward, with good intent, but the way it's implemented, all the other things that get in the way of it, it turns into something you hardly recognize as the good thing you had in mind," he said.