Face-to-Face Encounter Final Rule Guidance for Preparation NHPCO November 2010 © NHPCO 2010.

Face-to-Face Encounter Final Rule

Guidance for Preparation

Face-to-Face Encounter Final Rule

Guidance for Preparation

NHPCO November 2010NHPCO November 2010

© NHPCO 2010

© National Hospice and Palliative Care Organization, 2010

The CMS final ruleThe CMS final rule

• Will require a hospice physician or nurse practitioner to have a face-to-face encounter with each hospice patient before their 180-day recertification and for each 60-day recertification period after that date.

• Will better enable hospices to comply with hospice eligibility criteria, and to identify and discharge patients who do not meet those criteria.


What the statute does not permitWhat the statute does not permit

• Does not permit use of a PA or other non-physician practitioner– A change in the statute would be

required

• Does not permit use of telemedicine to perform the visit


The processThe process

• Face-to-face encounter– Attestation for the face-to-face

encounter

• Brief narrative, using face-to-face encounter findings– Attestation for the narrative

• Recertify patient for next benefit period


Recertification Care MapRecertification Care Map


Who can provide the face-to-face encounter?Who can provide the face-to-face encounter?

Physicians• Employed by the hospice • Working under contractual arrangement with a

hospice • Hospice maintains control• Duties – ALL THREE

Conduct face-to-face encounter Compose narrative Sign recertification

• Residents and fellows can serve• Attendings cannot do the face-to-face without

becoming a “hospice physician”


Who can provide the face-to-face encounter?Who can provide the face-to-face encounter?

Nurse practitioners• Can conduct face-to-face encounter• Provide the clinical findings to the physician

who is considering recertifying the patient • Cannot certify or recertify terminal illness

(statutory requirement from 1983)• Must be a W-2 employee

Full time Part time Per diem


When NP does face-to-face encounter…When NP does face-to-face encounter…

• The face to face attestation should include a statement that the clinical findings of that encounter have been provided to the certifying physician for use in determining continued eligibility for hospice care.


Benefit periods/180 daysBenefit periods/180 days

• Based on benefit periods and not on actual days of care.

• Regulations in 418.22 now require that the benefit period be included on the certification form


Timing of face-to-face encounterTiming of face-to-face encounter

• Face-to-face encounters may be completed no more than 30 calendar days prior to the effective date of the 180-day recertification.

• Face-to-face encounters may be completed no more than 30 calendar days prior to the start of each subsequent benefit period as part of the recertification process.

• Gives hospice providers more time to schedule and complete the face-to-face encounter


Timing of recertification processTiming of recertification process

Element

• Face-to-face encounter

• Accompanying attestation

• Brief narrative

• Attestation

• Recertification complete

Time Frame

• Up to 30 days prior to recertification

• Up to 30 days prior to recertification

• No more than 15 days prior to recertification




Transitions on January 1, 2011Transitions on January 1, 2011

• Patients who enter 3rd benefit period or later before the end of 2010:– No face-to-face encounter required

until the recertification period is reached after January 1, 2011

• Patients who enter 3rd benefit period or later after January 1, 2011– Face-to-face encounter required


Where can encounter take place?Where can encounter take place?

• No requirement that the visit must take place in the patient’s home

• Could also take place in practitioner’s office

• Hospice is required to determine whether travel to the practitioner’s office:– optimizes patient comfort– is consistent with the patient’s and

family’s needs and goals• Ambulance transport not separately

reimbursable


Checking Hospice HistoryChecking Hospice History

• Use Common Working File (CWF)

or• Health Insurance Portability and

Accountability Act (HIPAA) Eligibility Transaction System (HETS)– 270/271 transaction

• MAC can provide an internet portal • The HETS system can be a data

source for patient benefit periods and eligibility


TransfersTransfers

• When a patient in the 3rd or later benefit period transfers to a new hospice– Receiving hospice must recertify the

patient– Face-to-face encounter for that

current period is not required if new hospice can verify that the previous hospice provided the visit


New Patient with Other Hospice ServicesNew Patient with Other Hospice Services

• Face-to-face encounter is required “prior” to the 180-day recertification

• Verbal certification within 2 days• Written certification, including:

– Narrative– Attestation

• Must be completed prior to filing the claim


Recertification Care Map- MAP – New Patient With Previous Hospice CareRecertification Care Map- MAP – New Patient With Previous Hospice Care


Is the encounter a billable visit?Is the encounter a billable visit?

• No, the Face-to-Face Encounter considered an administrative function of the hospice physician

• If a non-administrative service, such as symptom management, is provided – hospice bills that portion of the encounter to Part A– Documentation for visit needed, whether

administrative or for services beyond the face-to-face

– Documentation – clear and precise


More on billingMore on billing

• NPs may bill only if they are serving as the patient’s attending

• Hospices may not bill patients for face-to-face encounters or for any medically necessary physician services provided during the encounter, as these are hospice services


Face-to-Face Attestation statementFace-to-Face Attestation statement

• The attestation is a statement from:– Hospice physician or NP

• Attests that he or she had a face-to-face encounter with the patient

• The clinical findings of that encounter have been provided to the certifying physician for use in determining continued eligibility for hospice care


Attestation statementAttestation statement

• The attestation should include:– the name of the patient visited– the date of the visit– signature and date by the NP or

physician who made the visit

• Note: The date of encounter does not have to match the date that the attestation was signed; however, both dates should be included.



• Can use other attestation language, provided that it incorporates required elements

• Elements of attestation suitable for – NP – Physician

• Certifying hospice physician MUST be the same physician who made the visit



Where should the attestation be located?• The attestation and signature can be either:

– a separate and distinct area on the recertification form, or

– a separate and distinct addendum to the recertification form, that is easily identifiable and clearly titled.

• The attestation language should be located directly above the physician or NP signature and date line.


Electronic signaturesElectronic signatures

• Electronic signatures are permitted on hospice certifications and recertifications

• Narrative and the face-to-face attestation are parts of the certification or recertification -- may also be signed electronically


Hospice Risk ManagementHospice Risk Management

• Face-to-face requirement is part of the hospice recertification process

• CMS can demand and recoup payments if face-to-face encounter is not provided


New Tools & Resources from NHPCONew Tools & Resources from NHPCO

“Clean COPS” – hospice regulations with new provisions included

Face-to-Face Final Rule – PDF Pull Out Initial Certification Tip Sheet Recertification Tip Sheet Initial Certification Sample Forms Recertification Sample Forms Admission Care Map – Revised Recertification Care Map Initial Certification Audit Tool Recertification Audit Tool PowerPoint for Staff In-Service Frequently Asked Questions


Questions?Questions?

Face-to-Face Encounter Final Rule Guidance for Preparation NHPCO November 2010 © NHPCO 2010.

Documents

Transcript of Face-to-Face Encounter Final Rule Guidance for Preparation NHPCO November 2010 © NHPCO 2010.