House Lawmakers Agree that Face-to-Face Woes Must End

The voices of home health providers advocating against Medicare face-to-face documentation requirements have been heard by lawmakers — and providers have reason to be hopeful.

The face-to-face documentation requirements, as they stand, are “one of the greatest burdens” faced by home health providers today, according to Sarah Myers, executive director of the Oregon Association for Home Care.

Myers testified at an Oct. 1 House Committee on Energy & Commerce Subcommittee on Health hearing titled “Examining Potential Ways to Improve the Medicare Program.”


“Simply put, this important safeguard has been implemented with impossible-to-meet documentation requirements that go well beyond what was written in the law by Congress,” Myers explained to lawmakers in her written testimony.

Home health providers are encountering various problems with the requirements, Myers said, including “a lack of standardization” and “rampant inconsistencies.”

Myers said thousands of claims have been denied due to “insufficient documentation,” despite the fact that a review of the full patient record shows that the patient meets Medicare coverage criteria. Examples given include cases of missing signatures on completed forms and descriptions deemed inadequate by reviewers.


U.S. Rep. Greg Walden (R-Ore.) is authoring legislation that would create a simple approach to documenting doctors’ face-to-face encounter with their patients, Myers told the committee. The reform would guarantee the policy is clearly and logically upheld through physician recording of the date of the encounter and use of a standardized form to identify the clinical condition for which home health is required.

Congressman Walden’s proposed solution will also guarantee that the Centers for Medicare & Medicaid Services (CMS) provides education to physicians, providers and claims processors so that a consistent application of the program integrity requirement is achieved to guarantee complete compliance, Myers said.

“We need this legislation — it will preserve your good program integrity policy while reducing unneeded paperwork and enabling us to continue serving homebound seniors in Oregon and all across America,” Myers concluded.

U.S. Rep. Joseph Pitts (R-Pa.) called the three bills discussed at the hearing, including Congressman Walden’s proposed bill, “very important, bipartisan, noncontroversial” bills that are expected to move “very soon.”

Similarly, both Democratic and Republican members of the subcommittee expressed support for the bills. U.S. Rep. Ben Ray Lujan (D-N.M.) thanked Myers for taking the time to come to the hearing and said he looked forward to working with Congressman Walden on the issue. U.S. Rep. Renee Elmers (R-N.C.) said the legislation is about “trying to make things better.”

Meanwhile, in a press release, the Partnership for Quality Home Healthcare thanked the House Energy & Commerce Subcommittee on Health for holding the Congressional hearing.

The coalition of home health providers said legislative reform currently under consideration directs CMS to use a standardized form, developed in consultation with stakeholders, to document beneficiaries’ eligibility for home health services.

“This common-sense reform would also establish a process for review of inappropriately denied claims, ensure educational outreach to key players, and provide for a study and report to Congress on the effectiveness of this streamlined process,” the coalition said.

The face-to-face requirement has led to ongoing legal actions from one of the country’s largest home health provider associations. The National Association for Home Care & Hospice (NAHC) has sued CMS, claiming that imposing the face-to-face requirement exceeded CMS’ statutory authority, and that CMS needs to take steps to resolve ongoing payment disputes related to the requirement.

Written by Mary Kate Nelson

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