Updates are being made to IBC medical policies for face-to-face encounter
requirements for home health and durable medical equipment (DME) services, as
detailed in this article. If you have any questions regarding these medical
policy updates, please contact your Network Coordinator.
Home health services
Effective July 22, 2014, Medical Policy #02.01.01c: Home Health Care Services
will be updated to include the requirement of a face-to-face encounter by the
certifying professional provider prior to certifying a member?s eligibility for
home health care services. Therefore, new requirements regarding the
face-to-face encounter will be included in the policy.
Prior to certifying an individual's eligibility for home health care services,
the certifying professional provider must document that (1) a face-to-face
encounter has occurred with the member, either with the certifying professional
provider or another professional provider and (2) the following requirements
are met:
The face-to-face encounter occurred within 90 days prior to, or within 30 days
after, the start of home health care.
In situations where a professional provider is ordering home health care for
the member involving a new condition that was not evident during an encounter
within 90 days prior to the start of home care, the certifying professional
provider must see the individual within 30 days after the start of home health
care services.
Please visit our
Medical
Policy Portal to review the notification for Medical Policy #02.01.01c:
Home Health Care Services in its entirety.
DME services
IBC requires that DME providers include documentation for detailed written
orders for face-to-face encounters conducted by professional providers for
specific DME items and their associated codes. As a result, the following will
be included in applicable DME-related medical policies:
Documentation of a face-to-face encounter between the treating professional
provider and the individual meeting the requirements listed in the medical
policy, including an assessment of the individual's clinical condition
supporting the need for the prescribed DME item(s), must be provided to and
kept on file by the DME supplier.
The face-to-face encounter requirement ensures that the orders and
certification for DME are based on a professional provider's current knowledge
of the individual's clinical condition. This requirement is consistent with the
Centers for Medicare & Medicaid Services' face-to-face encounter requirements
for covered DME items.
Go to our
Medical Policy
Portal for more information about our documentation requirements for DME
services.