Recent CMS Guidance Clarifies Physician Face-to-Face Home Health Certification Responsibilities

In MLN Matters Number MM9119 issued on April 10, 2015, CMS published manual updates to the physician certification and recertification requirements for home health care.  CMS stated that it is putting the following three changes to the face-to-face requirements in place: Elimination of the narrative requirement. The date and attestation of the physician’s face-to-face encounter will still be required and there must be supporting documentation in the physician’s or post-acute provider’s medical records. If an HHA claim is denied the… Read More >

Physician Certification of Home Health Patients For Remuneration Found to be “Referral” and Violation of Anti-Kickback Statute

On February 10, 2015, in the case of United States v. Patel, the Seventh Circuit Court of Appeals affirmed the judgment of the District Court which found Dr. Kamal Patel, an internal medicine specialist, guilty of violating the Anti-Kickback Statute.  The case resulted from a federal investigation which revealed that Dr. Patel had received payments from Grand Home Health Care (“Grand”) for certifying and recertifying home care patients’ plans of care. Dr. Patel’s argument on appeal was that the certification… Read More >

CMS Announces Extension of Temporary Moratoria on Enrollment of New Home Health Agencies and Part B Ambulance Suppliers in Six States

In the January 29, 2015 Federal Register, CMS announced a six-month extension of the temporary moratoria on the enrollment of new home health agencies (HHAs), HHA sub-units, and Medicare Part B ambulance suppliers in designated geographic areas in Florida, Illinois, Michigan, Texas, Pennsylvania and New Jersey. The CMS notice indicates that the decision to extend the moratoria was based on CMS’s determination of “a high risk of fraud, waste, or abuse in these provider and supplier types within these geographic… Read More >

ACO Homebound Waiver for Home Health Proposed by CMS

The Medicare Shared Savings Program Accountable Care Organization Proposed Rule published in the Federal Register on December 8, 2014 proposes to allow certain Accountable Care Organizations (ACOs) to waive the “homebound” requirement that is currently a precursor for Medicare beneficiaries to receive the Medicare home health benefit. The purpose of the waiver is to allow certain ACOs to offer home health services to patients where they believe it will keep patients out of the hospital, resulting in reduced overall costs… Read More >