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Case #2: Home Health
The Patient Protection and Affordable Care Act (ACA) requires that physicians(or certain practitioners working with them) who certify beneficiaries as eligible for Medicare home health services document—as a condition of payment for home health services—that face-to-face encounters with those beneficiaries occurred. This study (1) determined the extent to which physicians who certified home health care documented the face-to-face encounters, (2) described the nature of face-to-face documentation, and (3) assessed the Centers for Medicare and Medicaid Services’ (CMS) oversight of the face-to-face requirement.
HOW WE DID THIS STUDY
We reviewed 644 face-to-face encounter documents to analyze the extent to which the documents confirmed encounters and contained the required elements. We interviewed the four Home Health and Hospice Medicare Administrative Contractors (HH MACs) to describe how they ensure that home health agencies met the face-to-face encounter requirements. We also reviewed guidance documents and policies from CMS or the HH MACs about monitoring the face-to-face requirement.
WHAT WE FOUND
For 32 percent of home health claims that required face-to-face encounters, the documentation did not meet Medicare requirements, resulting in $2 billion in payments that should not have been made. Furthermore, physicians inconsistently completed the narrative portion of the face-to-face documentation. Some face-to-face documents provide information that, although not required by Medicare, could be useful, such as a printed name for the physician and a list of the home health services needed. CMS oversight of the face-to-face requirement is minimal.
- What is home health care and the types of services they provide?
- How are home health agencies paid and what services are covered?
- What is the purpose of the Medicare Home Health Face-to-Face requirement?
- What are some solution’s CMS should implement to ensure that all patients that need a face-to-face encounter receive one?
Important Guides lines for the case study.
Failure to follow these directions (listed in #1-5) will result in an automatic 10 percentage point deduction from the assignment’s total point value.
For all written assignments and papers, Turnitinwill be used to review the papers that you submit in this course. Turnitin is the anti-plagiarism software being used in Canvas. Turnitin does not determine whether plagiarism has taken place or not. Turnitin will also not be used as a punitive tool or measure. The instructor of this class will use the reports that Turnitin generates as a basis for the thorough evaluation of the authenticity and originality of your work and the work of your classmates.
Result of a high originality report can come from attempting to recycle your own work (NOT ACCEPTABLE and it is considered to be academic misconduct (self plagiarism) or someone else’s work(NOT ACCEPTABLE and it is consider to be academic misconduct) from another course or semester, inaccurately citing the work of someone else, failing to give credit to someone else for his or her ideas or writing, failing to summarize or paraphrase a quote in your own words, or anything else that falsely represents any part of your work. In short, be honest with your reader and yourself. Merely including a citation (in text citation) at the end of a sentence, paragraph, or entire paper that contains copied and pasted content from another source constitutes plagiarism. Know when and how to use APA or the required documentation style for your class or course of study, and be sure to accurately implement it. If you are unsure on how to properly cite your references, please reach out to your professor.
Make sure you are completing your written assignments in your own words. You can utilize outside resources to support your thoughts and opinions, however, make sure you are not utilizing in text citations/references for your entire written assignments. When you answer a question do not just write down ideas/things from your head – try and cite the book, notes, an article you might have read, another textbook etc. to back up your point and give your answer credibility. Most importantly, DO NOT copy word for word from the book or notes as this can be considered plagiarism. If you want to use a direct quote from the book that is fine, but you must cite it properly with quotes around it and the source. Quotes longer than two sentences should be cited as a block quote (indented, single space). Again, do not just use info from your head- take a position on the subject and back it up with cited facts.
You will analyze the case study and answer the questions that pertains to each case study. Answers should be between 1-2 pages and must be supported with literature. 1-2 citations need to be included from a peer-reviewed journal. Please follow the written assignment guidelines found in the syllabus.
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