Hospice Face to Face Rules

For recertifications on or after January 1, 2011, a palliative care physician or nurse must meet face-to-face with each palliative care patient before the start of the patient`s third benefit period and before each subsequent benefit period. Non-compliance with personal dating requirements. leads to the fact that the hospice does not meet the recertification of the eligibility requirement for incurable diseases by the patient. The patient would no longer be entitled to the benefit. [3] Before applying to the CGS, hospice palliative care organizations should ensure that: The physician or NP must confirm in writing that they have had an AGV meeting with the patient, including the date of the meeting. The certificate, which is a separate and autonomous part of the recertification or in addition to the recertification in relation to the 3. must meet the following criteria: The AGV meeting must take place within 30 calendar days prior to the start of the 3rd performance period and each subsequent recertification. In documented exceptional cases, in the case of a new admission to palliative care during the third or subsequent period of representation, the AGV meeting is considered appropriate if it is conducted within 2 days of admission. Examples: The AGV meeting must be performed by a palliative care physician or NP from the hospice. The hospice doctor must be employed by the hospice, a volunteer or work under contract.

The hospice NP must be employed by the hospice (receives a W-2 form from the hospice or a volunteer for the hospice). If the personal meeting was conducted by a nurse, the nurse must also confirm that the information gathered during the meeting was provided to the certifying physician. To implement the new legal requirement, the Centers for Medicare & Medicaid Services (CMS) made changes to 42 C.F.R. § 418.22(a)(3), (a)(4), (b)(3), (b)(4), and (b)(5). The new rules are expected to enter into force on 1 January 2011. However, to allow vendors to create the operational protocols needed to meet the requirements of face-to-face meetings, full implementation was delayed. In the meantime, CMS has published a guideline that sheds more light on how the law has been interpreted and how it will be implemented. This new policy can be found in Chapter 9 of the Medicare Benefit Policy Manual. [1] As of April 1, 2011, Medicare-certified hospices must fully meet the in-person meeting requirements. Effective compliance with face-to-face meeting requirements, which now apply to the certification of patients receiving palliative care services, requires appropriate documentation of the visit. In cases where a hospice admits a new patient who is on the third or later benefit period, exceptional circumstances may prevent an in-person meeting prior to the start of the benefit period.

For example, if the patient is on emergency admission on the weekend, it may not be possible for a doctor or [nurse] to see the patient until the following Monday. Or, if CMS data systems are not available, the hospice may not know that the patient is in the third performance period. In such documented cases, a personal meeting that takes place within 2 days of admission is considered appropriate. In addition, for such documented exceptional cases, if the patient dies within 2 days of admission without a [personal] meeting, a [face-to-face] meeting may be considered closed. [2] Hopefully, the “face-to-face” meeting will have the desired effect of encouraging physician participation not only in the certification process, but also in the general care of palliative care patients. However, this new requirement still creates the unresolved concern that it makes palliative care in the third and subsequent certification periods more difficult and potentially more costly for providers than patient care in the first and second certification periods. This could be a significant barrier to caring for dying Medicare beneficiaries and is therefore an issue that needs to be closely monitored. Because exceptional circumstances sometimes prevent providers from having face-to-face meetings prior to admission, CMS created the following policy: “While the doctor or nurse may perform a physical exam at the time of the meeting, it is not mandatory,” says Judi Lund Person, MPH, vice president of compliance and regulatory leadership at the National Hospice and Palliative Care Organization.

In addition to the face-to-face meeting required for recertification after 180 days of care, there are also specific requirements to certify patients in their first and second stages of care, says Lund Person. In all cases, a doctor must do the actual certification, even if the meeting is conducted by a nurse who provides information to the doctor, she adds. The required personal meeting must take place before the start of the recipient`s third period of palliative care service and again before all subsequent benefit periods. Since Medicare beneficiaries have an unlimited number of benefit periods available, palliative care providers must first determine whether each beneficiary needs a face-to-face meeting before accepting palliative care beneficiaries. To do this, CMS asked palliative care providers to use the joint work file. The Common Working File tracks hospices` certification periods by filing providers` palliative care choice statements with their Medicare contractors. However, this system has a serious flaw. Currently, there is no mandate for suppliers to submit election returns immediately. At this point, providers must submit election statements to their Medicare contractors before billing time, but they have one year to bill for the care provided. This flaw causes significant delays in the accuracy of the system and, if not corrected, could result in future financial liability for Medicare palliative care providers and recipients.

For Medicare palliative care patients entering their third benefit period or a subsequent benefit period, the above requirements are required as well as the following requirements: Eligibility for Medicare palliative care coverage depends in part on a palliative care physician certifying that the beneficiary has a life expectancy of six months or less if the incurable disease runs its normal course. In an effort to encourage physician commitment to certifying patients as eligible for Medicare palliative care, Congress amended Section 1814(a)(7) of the Social Security Act through Section 3132 of the Affordable Care Act to require a personal meeting by a palliative care physician or nurse with each hospice patient to determine that patient`s continued eligibility. before the 180-day recertification. and prior to subsequent recertification. In addition, the law requires the hospice doctor or nurse to certify that such a visit has taken place. Recertification related to a patient`s third period of performance in palliative care and any subsequent recertification must include documentation that a physician or palliative care nurse has had a face-to-face meeting (AGV) with the patient. The AGV meeting should document clinical outcomes supporting a life expectancy of 6 months or less. If AGV requirements are not met, the patient is no longer eligible for Medicare palliative care service. This statement should be extended in order to clarify the issue of liability. In other words, if certification is not obtained, who — the provider or the recipient of Medicare — is financially responsible for the palliative care provided? The answer to this question is to be found in the Rules of Procedure.

They specify that if a recipient “would be entitled to a payment if the claimant had on file the attestation and recertification required by a physician with respect to the services provided to the recipient,” the claimant “agrees not to bill [the] recipient.” [4] In other words, if the provider does not meet the personal contact requirement before the third performance period and before each subsequent performance period, the provider should be financially responsible for the care provided. To avoid future confusion, the Medicare Policy Guide should be amended to address this issue. Signed and dated certificate of personal meeting indicating that the hospice doctor or nurse held the personal meeting.