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Home Health Care Policies: Face to Face Requirement Lawsuit Proceeds

Posted by Nathan Hope on Jan 7, 2015

Home Health Care Policies- The National Association for Home Care and Hospice (NAHC) has filed a lawsuit this year challenging the face-to-face requirements set forth by CMS. Last June, the NAHC board of directors approved the lawsuit to be set forth and remarked that the regulations have caused a “dramatic upsurge in the retroactive denials of patient claims for payment under Medicare,” according to an NAHC Report

14-11-04-CMS

According to NAHC, the claim denials were due to the absence of information in paperwork, such as the justification for their homebound status or necessity of care. The group clarified that not meeting physicians face-to-face did not contribute to the claim denials mentioned. Andrea Devoti, chairman of the NAHC Board of Directors, mentioned in a public release, “This new regulation, which had the goal of improving the quality of care, has had the opposite effect” and “it has created a crisis and is denying the infirm elderly the care that they need which is why we had no choice but to take out case to Federal Court.”

NAHC also claims that the regulations set forth by CMS were violations of the Constitution and Medicare act due to the lack of clarity while also failing to provide “adequate, reasonable, and clear guidance” regarding compliance standards, as well as what actually constitutes as “sufficient” physician narratives for patient documentation. NAHC also scrutinized the claims denial process by stating that claims were denied based on third-party contractor decisions, and that patients’ medical records were not thoroughly analyzed to accurately determine the actual homebound status of the patients.

The actual face-to-face requirement was set to become effective January 1, along with several other implementations set forth by CMS before its reversal in June of last year. However, a federal court has given the go-ahead on the pending lawsuit so that proceedings may occur and a decision can be made regarding the issue, despite the government’s request that the case be dismissed.

The lawsuit addresses several items related to the face-to-face requirements, along with roughly $259 million dollars that are owed to agencies that provided care during the time that the claim denials mentioned were taking place.

NAHC President Val J. Halamandaris said in a press conference:

“This great victory in federal court means that Medicare patients, physicians, and the home health community will have their day in court. It is a clear signal that a federal judge also does not see why a rule which CMS had invalidated effective January 2015 should be honored for the years 2011, 2012, 2013, and 2014. There is no reason why the home care community should not be paid for the services it rendered in good faith to Medicare home health beneficiaries.”

 

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