Oral arguments are slated for Aug. 6 in the lawsuit the National Association for Home Care & Hospice (NAHC) filed challenging the original face-to-face requirement for a referring physician narrative.
 
NAHC believes the requirement for a narrative wasn’t authorized under the Medicare statute. CMS believes its narrative requirement was acceptable.
 
Meanwhile, the defendant and plaintiff recently filed motions for summary judgment in the case at the U.S. District Court in Washington, D.C.
 
Although CMS removed the face-to-face narrative requirement for episodes beginning Jan. 1, 2015, it has made clear that it expects to see documentation within a patient’s medical record verifying why the patient is eligible for home health services.
 
CMS also has refused to “address the past harm that the rule and its administration have caused along with the potential of applying the rescinded narrative requirement in future claims reviews” covering the timeframe in which the narrative was required, NAHC argues in its May 7 motion.
 
Because of narratives deemed insufficient, there have been improper denials of Medicare coverage for services to beneficiaries who otherwise would meet standards for payment, NAHC says.
 
“Only through full record reviews do Medicare beneficiaries and their providers of home health services receive the fair consideration of the claim for payment intended by Congress,” NAHC argues. “Only through that full review can Medicare avoid a payment denial that is in conflict with the true clinical condition and needs of the home health patient.”
 
In addition, NAHC argues, the application of face-to-face requirements is confusing to doctors, agencies, patients and MACs. “This has led the contractors to evaluate claims in a manner that is inconsistent, arbitrary and inaccurate.”
 
For its part, the Department of Justice argues NAHC is incorrect in its claim that those tasked with operating the Medicare program “exceeded their authority by establishing a documentation requirement not authorized by statute.”
 
The Affordable Care Act states that physicians must document face-to-face encounters. To implement the requirement, those operating Medicare reasonably required that documentation should explain why the encounter’s findings support that a patient is homebound and requires skilled care, an April 6 motion from the defendant states.
 
Requiring an explanation why helps limit fraud because it better ensures that the meeting actually occurred, the motion adds.
 
Related links: View the motions for summary judgment at http://bit.ly/1E4czKY and http://bit.ly/1FiQ3oP.