Dive Brief:
- HHS can require physicians to submit a narrative justifying authorization of Medicare patients for home health care services without encroaching its ACA authority, a D.C. federal judge ruled Tuesday, Law360 reported.
- The National Association for Home Care & Hospice (NAHC) filed a lawsuit challenging the validity of Medicare's rule that physicians provide a narrative to document face-to-face patient encounters.
- U.S. District Judge Christopher Cooper, in his ruling, granted HHS "summary judgement" that the face-to-face law enacted by Congress was ambiguous and did not foreclose the interpretation of the word "document" that CMS established in its regulations.
Dive Insight:
The court concluded that the word "document" could include both the date of the encounter and a narrative of what the physician found during the encounter. NAHC had argued the rule limited the physician documentation to the date of the encounter. The court also held the narrative requirement was not unreasonable, arbitrary, or capricious, but it is a "reasonable way to verify that an appropriate encounter actually took place."
NAHC, in a prepared statement, said the Court's ruling "provides a crucial conclusion that can help home health agencies succeed in winning reimbursement in appeals of claim denials based on an 'insufficient narrative.'" The group explained Medicare "cannot go beyond that narrative requirement and 'second-guess the medical judgement of the patient's physician' regarding the narrative content."
The organization is evaluating the next best steps. It is expected bicameral, bipartisan legislation will be introduced that addresses both the current documentation standard as well as the now-abandoned narrative requirement that led to thousands of claim denials. Next steps could include an appeal, a motion for reconsideration, or settlement discussions.
Val J. Halamandaris, NAHC president, said, "Our fight to overturn these wrongful denials is not over. We will take every course of action to protect home health agencies from the wrongful denial of claims under the misguided physician narrative policy."