Medicare is paying billions of dollars to home-health providers without adequate documentation of patients’ needs by doctors, according to a new report by the Department of Health and Human Services Office of Inspector General.
The cost of caring for homebound patients is rising, and the government is trying to get a better grip on spending by requiring doctors to certify — with face to face examinations — Medicare beneficiaries’ eligibility for home health services, including intermittent skilled nursing care, physical therapy, speech therapy and part-time home health aide services. The OIG estimated that $2 billion in inappropriate payments were made in 2011 and 2012 because of inadequate compliance with the rule.
But home health agencies, which billed Medicare $19.5 billion for these services in 2010, view the rule as burdensome and vague, and worry it will impede in their ability to deliver care.
Beatriz Lamb, regional director of home health care and hospice for Franciscan St. Elizabeth Health in Indiana, said that they give care to around 120 patients and juggle documentation from about 80 doctors. “It does create delays in care, we can’t afford to go out without a face-to-face [certification] in hand and I don’t have leverage to get it done if I’m already seeing the patient,” Lamb said.
The face-to-face rule results from a provision of the Affordable Care Act and is designed to reduce inappropriate Medicare payments for home health services. The OIG’s assessment found that of the claims that required face-to-face encounters, 32 percent did not meet the Centers for Medicare & Medicaid Services rules on what doctors must document, and should not have been paid. Home health providers worry that CMS could later try to recover these overpayments.
The rule requires that certifying physician must fill out documentation that includes the physician’s title, signature and date of the face-to-face encounter. It must also include a brief narrative that describes that patient’s clinical condition and the way in which the patient’s clinical condition supports his/her home-bound status and the need for care.