NAHC Files Lawsuit on CMS Face-to-Face Encounters

The National Association for Home Care & Hospice (NAHC) filed a lawsuit that challenges the administration of the physician face-to-face encounter documentation requirement developed and administrated by the Centers for Medicare and Medicaid Services.  The lawsuit was filed June 5, 2014 in the U.S. District Court in Washington, D.C.

The lawsuit claims that CMS violated Medicare law in three respects:

1.       CMS violated the law that authorized the physician face-to-face encounter by requiring that the physician provide a narrative that explains why a patient is home bound and in need of skilled care.  The authorizing statue require only that the physician document that the encounter occurred.

2.       To the extent that CMS can require the physician narratives, CMS violated The U.S. Constitution and the Medicare Act by failing to provide adequate, reasonable, and clear guidance on the standards for compliance.  In other words, CMS must explain what constitutes “sufficient” narratives.

3.       CMS further violated Medicare law by allowing its contractors to deny payment retroactively based solely on the sufficiency of the physician narratives without reviewing the entire patient record to determine whether the patient is, in fact, home bound and in need for skilled care.

NACH had previously reached out to CMS and tried to resolve the issues, but CMS was not willing to reach an agreement.  We support the NAHC lawsuit and hope that all of our clients, subscribers and friends will also support the lawsuit.

You can read the Compliant filed in federal court by using this link: http://www.nahc.org/assets/1/7/NAHCVSEBELIUSComplaint060514.pdf