Effective Documentation to Ensure Compliance with F2F and Other Home Health Certification Requirements

Event Information
5 Days
Left To Register
Product Format
Live Audio Conference
Judy Adams, RN, BSN, HCS-D, AHIMA approved ICD-10-CM Trainer
Conference Date
Add to my calendar   Thu, Mar 30, 2017
Aired Time
1 pm ET | 12 pm CT | 11 am MT | 10 am PT
90 minutes
Product Description

Latest Guidance for Face to Face and Home Health Certification Documentation

Home health agencies are continually faced with challenges to receive appropriate payment for their claims. Face to Face (F2F) has been an exceptional burden since its inception in January 2011 with the constant changes in interpretation and documentation expectations. The denial rate based on inadequate or insufficient F2F documentation continues to average 59% of claims reviewed. Further, increased focus on documentation of home health certification and re-certifications in the last 2 years has added to the burden of denials for home health agencies.

As with nearly all aspects of home health, documentation is the key to successfully meeting home health requirements. That is especially true when home health agencies are confronted with Additional Documentation Requests (ADRs) related to Phase 2 of Probe and Educate or any medical review request. Under the Probe and Educate program mandate, there is no limit to the length of time a HHA can be subject to these reviews if greater than one denial is received in the claim sample.

States that are subject to pre-Claim Determination are required to submit documentation to support all home health episodes prior to billing services or experience a 25% reduction in payment for the episode even if the episode is determined to be covered. While this particular demonstration project is targeted to only a few designated states at the current time, it is expected that if the project results in significant savings to the Medicare program, it will be expanded to more states.

The primary focus of all of these projects is the certification/re-certification process since denial of those requirements results in a total claim denial. Home health agencies must be prepared to proactively avoid claim denials through effective, compliant documentation.

In this session, expert speaker Judy Adams, RN, BSN, HCS-D, HCS-O, will discuss the latest guidance for F2F and certification documentation to assist home health agencies to avoid denials and receive the reimbursement they are due for their claims. Get clarification and clear suggestions for proper documentation to ensure compliance with home health certification, including the face-to-face requirement.

The program will dispel incorrect rumors and provide samples of compliant documentation plus strategies to fully meet these requirements from the beginning. In addition, the program will discuss CMS guidance to its contractors regarding pre and post claim reviews and lessons learned from the first implementation of the Pre-Claim Determination Project. This session is especially important with the beginning of Phase 2 of Probe and Educate and the expansion of the Pre-Claim Determination Projects.

Session Highlights:

  • Identify the requirements for certification and re-certification of home health episodes.
  • Understand the focus and documentation requirements for Phase 2 of Probe and Educate which is being implemented nationwide.
  • Understand the process under Pre-Claim Determination that is being activated again for additional states along with strategies to successfully meet the challenges of these two programs.
  • Overview of Phase 2 of the Medicare Probe and Educate Audits –
    • Purpose
    • Sample size
    • Criteria for passing the audit
    • Necessary documentation
    • Highlights of deficient findings in Phase 1
  • Overview and Discussion of the Pre-Claim Determination Project –
    • What state is next
    • Focus and size of reviews
    • Frequently asked questions
    • Necessary documentation
    • Summary of findings from the Illinois experience
  • CMS Guidance to contractors on home health pre and post-claim reviews with specific information on the requirements for certification and re-certification documentation.
  • Current Face-to-Face requirements with samples of acceptable documentation and proactive strategies by the HHA to ensure the F2F documentation is acceptable to successfully meet the requirements that involve all members of the home health team.
  • Resources available to home health agencies including frequently asked questions, Medicare guidance and appeal options if claims are denied.

Why Attend?

Everyone involved in home health must be knowledgeable about the Probe and Educate and Pre-Claim Demonstration Projects and work together to ensure home health documentation is meeting the requirements so claims are paid on first submission. Survival of the health agency is dependent on submitting compliant claims and documentation to support the provision of documentation that supports both eligibility and coverage criteria.

Who should attend?

Home health staff with administrative, supervisory, quality improvement and compliance responsibilities plus clinical visiting staff and billing staff.

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

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About Our Speaker

Judy Adams - Home Health Coding Expert

Judy Adams, RN, BSN, HCS-D, HCS-O, has been involved in health care in numerous health care setting over the span of her career. She has been involved in nearly every aspect of home health care over the last three decades including direct clinical care, supervision, administration and quality improvement.

In 2009, she opened her own education and consultation company with a primary focus on...   More Info
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