Federal Court Gives Go-Ahead for Face-to-Face Lawsuit

A federal court has ruled in favor of a lawsuit moving forward that works for retroactive effect and pay around a face-to-face the home health industry has long been fighting.

The face-to-face rule, which was scheduled to take effect January 1 and would require specific physician participation for qualifying home health Medicare claims, was reversed in June following confusion and “chaos” among providers. The lawsuit followed.

Under the suit, filed by the National Association for Home Care and Hospice in June, the organization asks that the Centers for Medicare and Medicaid Services (CMS), which implemented the rule initially, to give the decision retroactive effect and pay claims that were denied between 2011 and 2014. The organization made appeals to CMS urging that it settle the suit by paying some $259 million owed to agencies that provided care during that time, NAHC explained Tuesday.


The court ruled against the government’s motion to dismiss the case, allowing it to move forward in court. NAHC says it intends to pursue suit.

“This great victory in federal court means that Medicare patients, physicians, and the home health community will have their day in court,” said NAHC President Val J. Halamandaris in a press release. “It is a clear signal that a federal judge also does not see why a rule which CMS had invalidated effective January 2015 should be honored for the years 2011, 2012, 2013, and 2014. There is no reason why the home care community should not be paid for the services it rendered in good faith to Medicare home health beneficiaries.”

Editor’s note: A previous version of this article reported in error that the face to face rule would apply to Medicaid claims. In fact the rule applies to Medicare claims. HHCN regrets the error. 


Written by Elizabeth Ecker

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