New England’s Senators Urge Action on ‘Face-to-Face’ Concerns

US Senators representing the New England states have stepped in to send a letter to CMS regarding the onerous medical review process relative to the Physician Face-to-Face Requirement being undertaken by National Government Services (NGS), which is the Medicare Administrative Contractor (MAC) for the region.

The state home care associations in the region, including the Home Care Alliance, worked together to draft the letter, gather data, and mobilize agencies to ask that Senators sign on to the letter.

The letter to CMS Administrator Marilyn Tavenner convey that the reviews and unjustified claim denials could “jeopardize seniors’ access to home health care” and that any measures meant to attack fraud and abuse should be clear, consistent and not threaten a beneficiary’s ability to receive needed care. The letter also highlights that, in some cases during 2014, withheld and denied reimbursements have exceeded the cost of a two-week payroll for some agencies.

While acknowledging the CMS final rule that changes the Face-to-Face Rule’s narrative requirement, the letter urges the following:

  • Explain what additional steps CMS will take to better ensure the clarity of the F2F regulations to prevent any further inconsistent denial of claims across the country;
  • Describe how you will ensure that patient care will not be compromised while the appeals of F2F denials are being considered;
  • Provide us with a current list of the outcomes of Medicare home health F2F denials and appeals across the country; and
  • Consider the feasibility of working with home health agencies to reopen or settle claims related to F2F in a manner that is equally fair to both taxpayers and home health providers.  Such considerations could include analysis as to whether an agreement similar to the administrative agreement process recently offered by CMS to hospitals that have a high volume of backlogged claim denials would be appropriate for backlogged home health claims related to F2F.

Nine of the twelve US Senators representing the New England region signed on, including both Massachusetts Senators Elizabeth Warren and Ed Markey. The Alliance thanks them for their continuing support of home health care issues and particularly efforts to improve the Physician Face-to-Face Requirement.

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