Friday, June 7, 2013

CGS Initiates a Widespread Home Health Probe on Face-To-Face Encounter Documentation

As a result of numerous errors identified by both CGS and the Comprehensive Error Rate Testing (CERT) contractor related to home health face-to-face (FTF) encounter documentation, CGS will be initiating a widespread edit for all home health providers.  The topic code for this review will be 52xxT (‘xx’ denotes various numbers) and the edit will select start of care home health claims equally across the provider community.  Once selected, the claims will be reviewed for valid FTF encounter documentation, medical necessity compliance with all CMS coverage guidelines, correct billing and coding.

In addition, beginning July 8, 2013, CGS will begin requesting the initial certification face-to-face (FTF) encounter documentation is submitted with all home health claims selected for Medical Review. The Centers for Medicare & Medicaid Services (CMS) clarified the “face-to-face encounter requirement is necessary for the initial certification, which is a condition of payment. Without a complete initial certification, there cannot be subsequent episodes.” (CMS FAQ # 44)

The previous was from CGS website: Site goes into additional details of examples of what should be included and what would be considered insufficient within FTF documentation. The site also recommends actions for agencies to prepare for this edit which will come in the form of an Additional Documentation Request (ADR) letter. They recommend:

  1. Checking for claims in the Additional Development Request status/location in the Fiscal Intermediary Standard System (FISS) at least weekly.
  2. Prior to submitting your documentation to CGS, ensure that it undergoes a review by a clinician at your agency.
  3. Mailing your documentation for claims selected to CGS by day 30.


  1. I found this post to be very educational. Thank you for broadening my knowledge of this subject. No doubt its a great piece of writing as well. Thank

    supported living providers

  2. I am always searching for informative information like this. This is the perfect blog for anyone who wants to know about this topic. It contains truly information. Your website is very useful.

    life alert montgomery county

  3. Reading this post reminds me of my good old room mate! He always kept talking about this. I will forward this post to him. Thanks!

    Need help in billing? Please visit:
    Medisoft Software

  4. I have been looking for this kind of post. Health care organization benefited more from Remote medical coding.Its eliminate the need to keep track of additional employees.Remote Medical coding allows medical coders to work from remote site or offsite.Remote Medical coders helps to make proper insurance claims

  5. Rajesh thank your post the blog I agree to you home care.

  6. Excellent post, thank you! Make sure you check out Home Instead Senior Care, a great provider of home care in Concord New Hampshire.

  7. Thanks for sharing the information.

    For more info : ICD Coding India

  8. Thank you for sharing with us,I too always learn something new from your post.

  9. Nice blog. I Enjoyed a-lots to read this blog. I must say it is very informative and good content. Keep It Up.
    Medical Coding online Training