Face-to-Face Encounters by Medical Directors

Learn more about the new face-to-face requirements that are going into effect on April 1, 2011 in an article written by Daymarck thought leader Elizabeth Hogue, a private practice attorney with extensive experience in healthcare law and policy.

Effective April 1, 2011, providers may not be paid for services rendered if patients have not had appropriate face-to-face encounters with physicians during required time periods. In order for home health agencies and hospices to be paid for services provided, documentation of these encounters must also meet applicable requirements. Many staff members of agencies and hospices have read communications from CMS, fiscal intermediaries, and other sources that seem to state that Medical Directors cannot provide face-to-face encounters and documentation of them in order to meet applicable requirements. This conclusion is stress-provoking for staff members because Medical Directors often refer a number of patients to them. If it is true that Medical Directors cannot complete face-to-face encounters and documentation of them, the new requirements are more likely to be problematic to implement.

On the contrary, Medical Directors and other referring physicians who receive payments from providers for their services may complete face-to-face encounters and documentation so long as the requirements of both the personal services and management contract safe harbor and the contractual exception are met, as described below.

It is important to note that the above requirements do not apply only to so-called “Medical Directors.” This requirement applies whether referring physicians who provide paid consulting services are called “Medical Directors,” “Medical Advisors,” “consulting physicians” or another title. In other words, the prohibition applies to all physicians who make referrals and are paid for services, regardless of their title.

For more information, download a PDF of the entire article.

©2011

Elizabeth E. Hogue, Esq.

All rights reserved.

No portion of this material may be reproduced in any form without the advance written permission of the author.