CMS May be Sued over Face-to-Face Requirements

The National Association for Homecare (NAHC) is laying the groundwork for a possible lawsuit against CMS’ implementation of the Affordable Care Act’s (ACA) home health face-to-face requirements. NAHC says that providers are frustrated with face-to-face denials and believe that more guidance and clarity on these new requirements is needed from CMS.

The three main arguments for the lawsuit are:

1. If a doctor provides the necessary information, claims shouldn’t be denied for lack of documentation if it is present in the rest of the medical record.

2. The requirement for the narrative is outside the authority granted to CMS by the ACA.

3. CMS isn’t following Medicare due process requirements to publish clear, concise guidelines for what it takes to comply with rules and regulations.

NAHC plans to talk with beneficiary advocates, disability groups, and others about potentially joining the suit. NAHC has also suggested that a hearing on Capitol Hill might help bring clarity to the issue.

AAHomecare will monitor this development closely and provide members with more information as it becomes available.

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