FacetoFace Encounter Final Rule Guidance for Preparation NHPCO

Face-to-Face Encounter Final Rule Guidance for Preparation NHPCO November 2010 © NHPCO 2010

The CMS final rule • Will require a hospice physician or nurse practitioner to have a face-to-face encounter with each hospice patient before their 180 -day recertification and for each 60 -day recertification period after that date. • Will better enable hospices to comply with hospice eligibility criteria, and to identify and discharge patients who do not meet those criteria. © National Hospice and Palliative Care Organization, 2010

What the statute does not permit • Does not permit use of a PA or other non-physician practitioner – A change in the statute would be required • Does not permit use of telemedicine to perform the visit © National Hospice and Palliative Care Organization, 2010

The process • Face-to-face encounter – Attestation for the face-to-face encounter • Brief narrative, using face-to-face encounter findings – Attestation for the narrative • Recertify patient for next benefit period © National Hospice and Palliative Care Organization, 2010

Recertification Care Map © National Hospice and Palliative Care Organization, 2010

Who can provide the face-to-face encounter? Physicians • Employed by the hospice • Working under contractual arrangement with a hospice • Hospice maintains control • Duties – ALL THREE v Conduct face-to-face encounter v Compose narrative v Sign recertification • Residents and fellows can serve • Attendings cannot do the face-to-face without becoming a “hospice physician” © National Hospice and Palliative Care Organization, 2010

Who can provide the face-to-face encounter? Nurse practitioners • Can conduct face-to-face encounter • Provide the clinical findings to the physician who is considering recertifying the patient • Cannot certify or recertify terminal illness (statutory requirement from 1983) • Must be a W-2 employee v Full time v Part time v Per diem © National Hospice and Palliative Care Organization, 2010

When NP does face-to-face encounter… • The face to face attestation should include a statement that the clinical findings of that encounter have been provided to the certifying physician for use in determining continued eligibility for hospice care. © National Hospice and Palliative Care Organization, 2010

Benefit periods/180 days • Based on benefit periods and not on actual days of care. • Regulations in 418. 22 now require that the benefit period be included on the certification form © National Hospice and Palliative Care Organization, 2010

Timing of face-to-face encounter • Face-to-face encounters may be completed no more than 30 calendar days prior to the effective date of the 180 -day recertification. • Face-to-face encounters may be completed no more than 30 calendar days prior to the start of each subsequent benefit period as part of the recertification process. • Gives hospice providers more time to schedule and complete the face-to-face encounter © National Hospice and Palliative Care Organization, 2010

Timing of recertification process Element • Face-to-face encounter • Accompanying attestation • Brief narrative • Attestation • Recertification complete © National Hospice and Palliative Care Organization, 2010 Time Frame • Up to 30 days prior to recertification • No more than 15 days prior to recertification

Transitions on January 1, 2011 • Patients who enter 3 rd benefit period or later before the end of 2010: – No face-to-face encounter required until the recertification period is reached after January 1, 2011 • Patients who enter 3 rd benefit period or later after January 1, 2011 – Face-to-face encounter required © National Hospice and Palliative Care Organization, 2010

Where can encounter take place? • No requirement that the visit must take place in the patient’s home • Could also take place in practitioner’s office • Hospice is required to determine whether travel to the practitioner’s office: – optimizes patient comfort – is consistent with the patient’s and family’s needs and goals • Ambulance transport not separately reimbursable © National Hospice and Palliative Care Organization, 2010

Checking Hospice History • Use Common Working File (CWF) or • Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS) – 270/271 transaction • MAC can provide an internet portal • The HETS system can be a data source for patient benefit periods and eligibility © National Hospice and Palliative Care Organization, 2010

Transfers • When a patient in the 3 rd or later benefit period transfers to a new hospice – Receiving hospice must recertify the patient – Face-to-face encounter for that current period is not required if new hospice can verify that the previous hospice provided the visit © National Hospice and Palliative Care Organization, 2010

New Patient with Other Hospice Services • Face-to-face encounter is required “prior” to the 180 -day recertification • Verbal certification within 2 days • Written certification, including: – Narrative – Attestation • Must be completed prior to filing the claim © National Hospice and Palliative Care Organization, 2010

Recertification Care Map- MAP – New Patient With Previous Hospice Care © National Hospice and Palliative Care Organization, 2010

Is the encounter a billable visit? • No, the Face-to-Face Encounter considered an administrative function of the hospice physician • If a non-administrative service, such as symptom management, is provided – hospice bills that portion of the encounter to Part A – Documentation for visit needed, whether administrative or for services beyond the face-to-face – Documentation – clear and precise © National Hospice and Palliative Care Organization, 2010

More on billing • NPs may bill only if they are serving as the patient’s attending • Hospices may not bill patients for face-to-face encounters or for any medically necessary physician services provided during the encounter, as these are hospice services © National Hospice and Palliative Care Organization, 2010

Face-to-Face Attestation statement • The attestation is a statement from: – Hospice physician or NP • Attests that he or she had a face-to-face encounter with the patient • The clinical findings of that encounter have been provided to the certifying physician for use in determining continued eligibility for hospice care © National Hospice and Palliative Care Organization, 2010

Attestation statement • The attestation should include: – the name of the patient visited – the date of the visit – signature and date by the NP or physician who made the visit • Note: The date of encounter does not have to match the date that the attestation was signed; however, both dates should be included. © National Hospice and Palliative Care Organization, 2010

Attestation statement • Can use other attestation language, provided that it incorporates required elements • Elements of attestation suitable for – NP – Physician • Certifying hospice physician MUST be the same physician who made the visit © National Hospice and Palliative Care Organization, 2010

Attestation statement Where should the attestation be located? • The attestation and signature can be either: – a separate and distinct area on the recertification form, or – a separate and distinct addendum to the recertification form, that is easily identifiable and clearly titled. • The attestation language should be located directly above the physician or NP signature and date line. © National Hospice and Palliative Care Organization, 2010

Electronic signatures • Electronic signatures are permitted on hospice certifications and recertifications • Narrative and the face-to-face attestation are parts of the certification or recertification -- may also be signed electronically © National Hospice and Palliative Care Organization, 2010

Hospice Risk Management • Face-to-face requirement is part of the hospice recertification process • CMS can demand recoup payments if face-to-face encounter is not provided © National Hospice and Palliative Care Organization, 2010

New Tools & Resources from NHPCO § § § “Clean COPS” – hospice regulations with new provisions included Face-to-Face Final Rule – PDF Pull Out Initial Certification Tip Sheet Recertification Tip Sheet Initial Certification Sample Forms Recertification Sample Forms Admission Care Map – Revised Recertification Care Map Initial Certification Audit Tool Recertification Audit Tool Power. Point for Staff In-Service Frequently Asked Questions © National Hospice and Palliative Care Organization, 2010

Questions? © National Hospice and Palliative Care Organization, 2010