MACs have reported that one of the top five reasons for claim denial is invalid physician certification, particularly when the necessary face-to-face (F2F) encounter was missing, incomplete, or untimely.
To receive payment, SOC certification must include F2F encounter documentation that identifies the primary reason for home care admission. Proper compliance with F2F documentation requirements is essential to avoid claim denials and non-affirmations, though obtaining updated F2F encounter documents from physicians can be challenging.
Below are some tips on how to obtain complete F2F documentation from physicians:
- Include a statement like the example below in the From Locator 26 of the CMS 485. Certification statements can take different forms as long as they meet the requirements for a valid F2F encounter note. If the physician certification statement used by the agency does not have the F2F encounter date, the example statement can be added to another section of the care plan.
- I certify that this patient is confined to his/her home and needs intermittent skilled nursing care, physical therapy, and/or speech therapy or continues to need occupational therapy. The patient is under my care, and I have authorized services on this plan of care and will periodically review the plan. The patient had a face-to-face encounter with an allowed provider type on (date) and the encounter was related to the primary reason for home health care. Physician’s Signature and Date Signed: John Doe, MD 11/05/2016
Physician’s Name and Address:
John Smith, MD
1234 Anchor Drive, Suite 5
Sacarmento, CA 94205
- I certify that this patient is confined to his/her home and needs intermittent skilled nursing care, physical therapy, and/or speech therapy or continues to need occupational therapy. The patient is under my care, and I have authorized services on this plan of care and will periodically review the plan. The patient had a face-to-face encounter with an allowed provider type on (date) and the encounter was related to the primary reason for home health care. Physician’s Signature and Date Signed: John Doe, MD 11/05/2016
- For the physician’s convenience in signing the CMS 485 form, you can attach a “Sign-Here” sticky note and mark it to indicate the location of the required signature. Additionally, the sticky note can be used to request the date of the most recent F2F encounter.
- To make order-signing more straightforward, make use of the Physician Portal feature in your EMR, which is usually available in most EMRs. Make sure that the Portal prompts the physician to enter the F2F encounter date.
- One way to promote your services is to utilize physician office visits as an opportunity for marketing. You can do this by providing progress reports that can be printed out during the visit, and sharing updates on your staff training and care planning efforts. To make the most of this marketing opportunity, consider implementing the following tips:
- Offering to track care plan oversight (CPO) can be an effective marketing strategy for physicians, as it makes it easier for them to bill Medicare for CPO.
- To facilitate the monitoring of home health care plans, consider providing physicians with a Careplan Oversight Documentation Form to help them track the time spent on this activity.
Getting new or updated F2F encounter documentation can be tough due to the need for coordination with the referring physician, who may be unavailable or unresponsive. To tackle this, make sure your coders are skilled enough to scrutinize the F2F information and identify when further documentation is genuinely required.