A Valid Face-to-Face Encounter Document Must be Submitted Upon Review of Home Health Start of Care Claims as Well as Subsequent Episodes

Since the implementation of the Medicare requirement for a beneficiary to have a face-to-face encounter with a physician or qualifying non-physician in order to be certified for home health care coverage, Palmetto GBA has been advising providers to include the face-to-face encounter documentation with all home health claims chosen for medical review.

Effective for claims received for processing in the claims system on or after August 1, 2014, when doing a review, we will enforce the requirement for the submission of a valid face-to-face encounter document. If the face-to-face encounter is missing from the medical documentation submitted for a home health claim or the submitted face-to-face is invalid, the claim will be denied. This will apply whether the claim is a start of care claim or a subsequent episode.