OIG examined home health claims from April 2011 through December 2012, when CMS began enforcing a Medicare requirement that a physician meet face-to-face with transitioning patients to certify home care is medically necessary.
About 10 percent of the claims for patients transitioning from hospitals and other settings to home care were missing the needed documentation to receive payment, and 17 percent were missing the certifying physician’s signature.
Currently, a physician who cared for the patient in a recent hospital or post-acute care setting may conduct the face-to-face encounter, and a separate certifying physician may document the encounter.
In its report, OIG recommends CMS consider requiring a standardized form to improve compliance with the requirement; provide additional training and outreach to physicians; and work with Medicare contractors to improve oversight and compliance.
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