NAHC Files Lawsuit Against CMS Over Face-to-Face Payment Claims

After months of planning, the National Association for Home Care & Hospice (NAHC) has finally filed its lawsuit last week against the Centers for Medicare & Medicaid Services’ (CMS) over allegations regarding the federal agency’s rule for face-to-face physician encounters. 

The NAHC Board of Directors approved the lawsuit before its June 5 filing, citing the CMS regulations have caused a “dramatic upsurge in the retroactive denials of patient claims for payment under Medicare,” according to an NAHC Report

NAHC alleges that CMS denied the payment claims because physicians did not supply sufficient paperwork such as a narrative explanation for their judgment that patients are homebound or in need of skilled care—not because physicians had failed to see patients or certify them for payment, the trade group said.

“This new regulation, which had the goal of improving the quality of care, has had the opposite effect,” stated Andrea Devoti, chairman of the NAHC Board of Directors, in a release. “it has created a crisis and is denying the infirm elderly the care that they need which is why we had no choice but to take out case to Federal Court.”

NAHC also brings forth allegations that CMS violated the U.S. Constitution and Medicare Act by failing to provide “adequate, reasonable, and clear guidance” on the standards for compliance, by emphasizing to define what constitutes “sufficient” physician narratives.

Another claim from NAHC states CMS violated Medicare law by allowing its contractors to deny payment retroactively based solely on the sufficiency of the physician narratives, without reviewing the entire patient record to determine whether a patient was home bound and in need of skilled care. 

“We filed the suit reluctantly only after we tried to make CMS understand that their regulation was redundant, amounted to bureaucratic overkill, created disincentives for physicians to order home care services, and was leading to the loss of care by thousands of Medicare patients who are so sick they cannot leave home without assistance,” stated NAHC President Val Halamandaris.

While the lawsuit is pending, NAHC says it will continue to work with Congress in hopes of a “legislative remedy.”

Read more about NAHC’s lawsuit. 

Written by Jason Oliva

Jason Oliva