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New Medicare Homecare Regulations: Effective January 1, 2011
- A physician (or a nurse practitioner or physician assistant) must have a “face to face encounter” with Medicare patients within the 90 days prior to, or the 30 days following, the start of home care services.
- These new regulations pertain only to traditional Medicare (not Medicare Advantage plan) patients.
- These regulations pertain only to the initial 60 day episode of care. There is no need to have a new “face to face encounter” for the recertification (second and subsequent) episodes of care.
- Documentation of the “face to face encounter” must be done under the physician’s signature, even if the visit was done by an APRN or PA. If the visit was done by an APRN or PA, that clinician must inform the physician of his/her findings for the purpose of documentation.
- “Face to face encounter” documentation must contain:
- The reason (diagnosis or problem) that the patient was seen.
- An explanation of how the need for home care relates to the reason for the visit.
- An explanation of why the patient is “homebound”.
- A statement of why skilled home care nursing or therapy is needed.
- Physician’s signature (date stamp not allowed) and the date of the “face to face” encounter.
- If the patient is an inpatient, and a community physician will be signing the plan of care and overseeing home care, the name of this community physician must be noted on the documentation.
- The “face to face encounter” documentation cannot contain “standard language” or check boxes. VNA Community Healthcare’s “Physician Guide to Medicare Home Care” (BELOW) provides further information about “homebound” and clinical indications for home care.
- A completed, signed and dated VNA Community Healthcare revised fax referral form (BELOW) meets the requirements for Medicare “face to face encounter” documentation.
- Fax the “face to face encounter” documentation to VNA Community Healthcare with the referral or at the latest, within one week of the start of care (fax numbers: 203.458.4388 or toll free 1.866.862.0999).
Notes about the current Medicare process
These new regulations make no changes in the regulation that pertain to the “Plan of Care” (Medicare form 485). This form must be signed and returned within 21 days of the start of Medicare home care.
The new regulations do not require the physician to submit any new documentation when billing Medicare for home care certification.
NEW Fax Referral Form - with Face to Face Encounter Documentation
PDF Document, 148 kB
Physician's Guide to Medicare Homecare
PDF Document, 172 kB
Face to Face Encounter Documentation - without a referral
PDF Document, 35 kB