Medicare program/Home Health Prospective Payment System Rate Update for CY2010:Physician Narrative Requirement, CY2011 Final Physician Face-to-Face Encounte
ICR 201012-0938-009 · OMB 0938-1083 · Historical Active
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Medicare program/Home Health Prospective Payment System Rate Update for CY2010:Physician Narrative Requirement, CY2011 Final Physician Face-to-Face Encounte
The Centers for Medicare and Medicaid Services (CMS) require that a physician sign every patient's individual plan of care certifying or recertifying that the patient is homebound and the planned services are medically necessary in order for the home health agency to be reimbursed for Medicare covered services as stipulated in 42 CFR 424.22. CMS is relying on physicians to fulfill a role that is sometimes thought of as a "gatekeeper" by requiring the physician to provide a narrative located within the home health certification or recertification when skilled nursing management & evaluation of the plan of care, (PoC) is ordered. The physician's narrative is required when a patient's underlying condition or complication requires a registered nurse to ensure that essential non-skilled care is achieving its purpose, The narrative must be located immediately prior to the physician's signature. If the narrative exists as an addendum to the certification or recertification form, in addition to the physician's signature on the certification or recertification form, the physician must sign immediately following the narrative in the addendum. This change supports Medicare's home health coverage criteria for skilled services as stipulated in the CFR, (see 42 CFR 409.42).The Home Health Prospective Payment System Rate Update for Calendar Year 2011 changes the certification requirements for Home Health Agencies. In the case of a certification made by a physician after January 1, 2010, prior to making such certification, the physician must document that the physician himself or herself or specified non-physician practitioner has had a face-to-face encounter with the patient incident to the services involved
The Affordable Care Act (PPACA) of 2010 (Pub. L. 111-148) was enacted. Section 6407 (a) (amended by section 10605) of the PPACA amends the requirements for physician certification of home health services contained in Section 1814 (a)(2)(C ) and 1835 (a) (2)(A) by requiring that, "In the case of a certification made by a physician after January 1, 2010, prior to making such certification, the physician must document that the physician himself or herself or specified non-physician practitioner has had a face-to-face encounter (including through the use of telehealth, subject to the requirements in section 1834 (m) of the Act)", with the patient incident to the services involved
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No
No
Yes
No
No
Uncollected
Bonnie Harkless 4107865666
No
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0938-1083_CMS-10311_Supporting_Statement_final_ 11-03 (2).doc
Home Health CY2011 proposed rule: Face-to-Face encounter, physician's burden for form completion, supporting regulation 424.22 (annual)