Medicare will pay for home health services only when a patient has had a face-to-face encounter with a physician certifying home health.
The face-to-face encounter must be:
- Made by the physician responsible for certifying home health (or nonphysician practitioner*)
- Related to the primary reason for which the patient requires home health services
- Made within 90 days prior to, or within 30 days after, the start of home health services
- Made prior to certifying the need for home care
The encounter must be documented on the home health certification, or an addendum to that certification and must include:
- Date of face-to-face encounter
- Indication that the encounter was related to the primary reason for home health
- An explanation of the clinical findings supporting the need for skilled nursing or therapy services
- An explanation of why the clinical findings of the encounter support that the patient is homebound
- The physician’s signature and date
*If you work in collaboration with a nurse practitioner or clinical nurse specialist, or otherwise supervise a physician’s assistant, the face-to-face encounter must be carried out by one of those nonphysician practitioners as long as they document their clinical findings and communicate those findings to you. Only a physician may order home health services, certify that a face-to-face encounter occurred, and certify that the applicable eligibility criteria are met (medical necessity and homebound status).