The Centers for Medicare and Medicaid Services (CMS) held an open door forum (ODF) for home health care, hospice, and durable medical equipment (DME) on Wednesday, Nov. 2.

When discussing the face-to-face physician encounter requirement, CMS stated that it is a statutory requirement. Because it is law, only Congress can change the law and CMS does not have this power. CMS said that they clarified several face-to-face physician encounter confusion points within the comments section of the final rule, including:

• Late Face-to-Face Physician Encounter – What needs to happen if the face-to-face physician encounter doesn’t occur in the mandated timeframe?
  • CMS referred to Section 80, Chapter 10 ^[1] in the Medicare Claims Processing Manual ^[2].
  • According to CMS, in certain instances a new start of care (SOC) OASIS assessment may be generated that reflects a SOC date equal to start of the beneficiaries change to Medicare Fee-For-Service. A prior OASIS can be used to generate a new SOC OASIS.
  • The manual allows for this OASIS completion flexibility in this situation to meet billing and eligibility rules. A late face-to-face physician encounter is another situation that justifies OASIS completion flexibility.
  • When the face-to-face physician encounter did not occur in the 90 days prior to the SOC or 30 days after the SOC, the provider may complete another OASIS with the SOC equal to the date where all Medicare eligibility is met. However, Medicare will not pay for services before the date of eligibility.

Click here to access the final rule. ^[3]