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Home Health Agency Regulatory Compliance

The health law attorneys of Fuerst Ittleman David & Joseph are knowledgeable about the various regulatory and compliance issues home health agencies face.

Home health agencies play a critical role in the care and treatment of Medicare and Medicaid beneficiaries.

Home health agencies accept patients for treatment with the expectation that the patient’s medical needs can be adequately met by the agency in the patient’s place of residence (42 C.F.R. § 484.18). Home health services include part-time or intermittent skilled nursing care; physical, occupational, and speech therapy; medical social work; and home health aide services. Please refer to the Medicare Benefits Policy Manual, Pub. No. 100-02, Ch. 7, § 40 for additional information.

In order to receive proper payment from Medicare and Medicaid, it is essential that a home health agency maintain adequate documentation of all aspects of a beneficiary’s care, including for example: initial certifications and plans of care, verbal orders, prescriptions, initial and follow-up home health nursing certifications, daily nursing notes, and physical therapy assessments and notes. In addition, section 6407 of the Patient Protection and Affordable Care Act mandates that, prior to certifying a patient’s eligibility for the home health benefit, the physician responsible for performing the initial certification must document that the physician or a permitted non-physician practitioner (“NPP”) (which includes a nurse practitioner, a clinical nurse specialist, a certified nurse-midwife, or a physician assistant) has had a face-to-face encounter with the patient (42 C.F.R. § 424.22). As part of this documentation, the physician or NPP must document that he or she:

1) saw the patient
2) the patient’s clinical condition at the time of the encounter supports the patient’s homebound status
3) the need for skilled services

The face-to-face encounter must occur no earlier than 90 days prior to the start of, and no later than 30 days after the start of, home health care. The certifying physician must document this face-to-face encounter either on the initial certification which the physician signs, or in a separate signed addendum to the initial certification. Inadequate clinical documentation often times can result in payment denials, audits, and subsequent overpayment determinations by Medicare Administrative Contractors (MACs).

The health care practice group of Fuerst, Ittleman, David & Joseph has successfully assisted clients in obtaining reimbursement through a multifaceted approach of ensuring adequate regulatory compliance, billing and coding accuracy, and litigation when necessary. Our Florida health care law firm has successfully represented clients before the Centers for Medicare and Medicaid Services, the Florida Agency for Health Care Administration, and the Department of Justice on a variety of issues including Medicare and Medicaid suspensions, overpayment appeals, prepayment reviews and audits, and health care fraud investigations. When necessary, our Florida health care attorneys will take the fight to CMS and AHCA challenging the validity of the very rules upon which the agencies claim their power. An example of our firm’s previous success in rule challenges can be read here.

As home health agencies increasingly draw the eye of federal and state regulators and law enforcement authorities, it is critical that the home agency and its attorneys have a high level of familiarity with the laws and regulations governing home health agencies. The health care lawyers at Fuerst Ittleman David & Joseph work with these laws and regulations on a daily basis and are frequently asked by health care clients for advice regarding how to comply. In many cases, our health care attorneys have been asked to litigate regarding these complex issues against the state and federal governments. Our Florida health care law firm has extensive experience litigating health care fraud cases.

Compliance is critical.  With health care, tax, corporate, litigation, and white-collar criminal defense practice groups, Fuerst Ittleman David & Joseph can provide comprehensive legal support for your home health agency.

For more information, please contact us at 305-350-5690 or contact@fuerstlaw.com.