A new law requires a face-to-face examination of home health care patients before certifying them as eligible to receive Medicare services. The requirement, effective January 1, 2011, includes physicians and non-physician practitioners (NPP) collaborating with attending physicians (including nurse practitioners) and ensures that physicians’ orders are based on current knowledge of a patient’s condition.
As part of the certification form itself, or as an addendum to it, the physician must document when the physician or an allowed NPP, saw the patient, and document how the patient’s clinical condition, as seen during that encounter, supports the patient’s homebound status and need for skilled services.
The face-to-face exam must occur within 90 days prior to the start of home health care, or within the 30 days after the start of care. If a physician orders home health care for a patient with a new condition not diagnosed during a recent visit, the patient must be examined within 30 days after admission.
In addition to allowing NPPs to conduct the examination, hospitalists can also examine and certify patients for Medicare eligibility. For professionals practicing in rural areas, the law allows for the examination to occur via telehealth in approved sites. Questions and answers regarding the new requirement can be found on Medicare’s home health agency website at http://www.cms.gov/center/hha.asp.
NYSNA continues to advocate for nurse practitioners to perform independent, face-to-face assessments.
For questions related to this alert, contact Education, Practice and Research: 518.782.9400, ext. 282