CGS Joins Palmetto GBA in In-Depth Review of Face-To-Face Documentation

CGS and the Comprehensive Error Rate Testing (CERT) contractor have found numerous errors related to the home health face-to-face encounter.  They have joined Palmetto GBA in a Widespread Home Health Probe in Face-To-Face Encounter Documentation.  The topic code for this review will be 52xxT (‘xx” denotes various numbers) and the edit will select start of care home health claims equally across the provider community.  Once selected, the claims will be reviewed for valid FTF encounter documentation, medical necessity compliance with all CMS guidelines, correct billing, and coding.

The Face-To-Face documentation, which must be a separate and distinct section of or an addendum to the Start of Care Certification must include:

1.      Clear title to show it is a FTF encounter (HHA may title documentation)

2.      The patient’s name

3.      The date of the encounter

4.      A description of the clinical findings during the encounter

5.      An explanation of how the clinical findings support homebound

6.      An explanation of how the clinical findings support the need for skilled home care

7.      The certifying physician’s dated signature

(HHA may enter date received if not dated by the physician)

This is similar to the probe initiated by Palmetto GBA in May.

For more information about the CGS probe use the following link:

http://www.cgsmedicare.com/hhh/pubs/news/2013/0613/cope22393.html

For more information about the Palmetto GBA probe use the following link:

http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Jurisdiction%2011%20Home%20Health%20and%20Hospice~CERT~General%20Information~Face%20to%20Face%20Documentation%20for%20Home%20Health%20Certification%20Important%20Information%20for%20Certifying%20Physicians%20and%20Non-physician%20Practitioners%20(NPPs)