The OIG recently reviewed the extent of physician compliance with an ACA requirement that physicians or certain clinicians who certify beneficiaries as eligible for Medicare home health services document that face-to-face encounters with those beneficiaries occurred according to program requirements. Based on a sample of 644 face-to-face encounter documents between April 1, 2011 (when CMS began requiring full compliance with the ACA requirement) and December 31, 2012, the OIG concluded that documentation did not meet Medicare requirements for 32% of home health claims that required face-to-face encounters, which the OIG estimates resulted in $2 billion in inappropriate payments. The OIG also found inconsistent physician completion of the narrative portion of the face to face documentation. The OIG characterizes CMS oversight of the face-to-face requirement as "minimal." In light of these findings, the OIG recommends that CMS: (1) consider requiring a standardized form for the face-to-face documentation; (2) develop a specific strategy to communicate directly with physicians about this requirement, and (3) enhance oversight. CMS concurred with these recommendations.
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