In a recent FAQ CMS published relating to the Pre-claim Review Demonstration for Home Health Services, CMS provided an interesting response to a question about what home health agencies (HHAs) should do if a certifying physician won’t provide documentation.
Post-acute care (PAC) providers, including HHAs, have been concerned with an inability to secure documentation from physicians and/or to secure timely physician visits in order to meet regulatory compliance expectations. In the FAQ, published 9/15/16, CMS provides –
Q. What should HHAs do if the certifying physician will not provide documentation?
A. CMS created an informational letter directed towards physicians that will be available for download on the Pre-Claim Review Demonstration for Home Health Services website. Home Health Agencies can give the letter to physicians reminding them of their responsibility to provide the documentation. If the physician and/or facility will still not provide the documentation, Home Health Agencies should notify their MAC or CMS (at HHPreClaimDemo@cms.hhs.gov) of the uncooperative physicians and/or facilities. Physicians and/or facilities who show patterns of non-compliance with this requirement, including those physicians and/or facilities whose records are inadequate or incomplete, may be subject to increased reviews, such as through provider specific probe reviews.
This statement from CMS reveals that it has started to hear and respond to PAC provider concerns about securing physician documentation in order to meet CMS compliance requirements. Real behavior change may come when providers use the process outlined and CMS follows up on complaints. However, whether or not providers actually use the process of notifying the MAC or CMS, given the referral relationship providers maintain with physicians, remains to be seen.