Physicians may want to pay close attention to requests from home health agencies to document a patient’s need for home care.
Buried at the very end of a Frequently Asked Questions document, the Centers for Medicare & Medicaid Services suggests that it could target doctors who don’t cooperate to provide home health agencies with the paperwork they need to certify a patient qualifies for services.
“This is potentially a groundbreaking development,” writes Ronald Hirsch, M.D., vice president of the regulations and education group at Accretive Physician Advisory Services, in a post for RAC Monitor.
In the FAQ, which deals with CMS’ home health demonstration project on pre-claim review to test methods for identifying Medicare fraud, the agency addresses the question of what home health agencies should do if a certifying physician will not provide documentation of a patient’s home-bound status and skilled needs.
CMS says it is has created an informational letter that home health agencies can give to physicians reminding them of their responsibility to provide documentation and certify a plan of care. If a physician or facility will still not provide the paperwork, home health agencies are advised to notify their Medicare administrative contractor (MAC) or CMS.
Physicians who “show patterns of non-compliance,” including those whose records are inadequate or incomplete, “may be subject to increased reviews, such as through provider specific probe reviews,” CMS wrote.”
While it may be good news for home health agencies seeking to get proper documentation from non-cooperative physicians, Hirsch says only time will tell if this is just “another idle threat” that rarely gets used. “Unless physicians actually know a colleague who has been audited, their behavior is unlikely to change,” he concludes.
The home health industry continues to be a hotspot with government agencies looking to crackdown on potentially fraudulent activity.