Face to Face Encounter

Isabelle49 · Apr 1, 2011

We're told that field nurses will be responsible for this. I don't see how, except to tell the patient/family about this necessity or d/c from home health.

KateRN1 · Apr 1, 2011

Our marketers have been given the bulk of the responsibility for getting the F2F signed and we have a biller who will be tracking these. We have a letter in the SOC packets for patients, and a sticker on the front of the home folder to indicate the date that F2F was done. I can see problems with getting the forms signed, but most of our patients have seen the MD, NP, or PA within the last 90 days, so the encounter itself is not an issue. We've always had a problem with non-physician providers trying to sign orders, 485s, etc, and that continues to be a problem with the F2F encounters.

CMS has approved the use of the HHABN Option Box 2 for notifying patients of discharge due to lack of F2F encounter, with the caveat of "timely notificiation," usually 2-7 days depending on state.

HmarieD · Apr 13, 2011

We have had problems with physicians completing the forms appropriately. Typically they ignore the homebound section. I heard of one doc who wrote "Quit wasting my time" across the form in big letters. The problem is that there is no financial repercussion for the physicians related to this, only for the HHA.

4evernrs · Apr 16, 2011

I commiserate with you all! F2F is truly proving to be the stumbling block that CMS intended it to be. What a PIA! Docs simply don't know what to write on the forms - yet we're not allowed to provide standardized language... We've had a variety of responses - some signed but blank, some completed yet signed inappropriately by RNs or staff other than MDs. We also are asking our reps to get them up front with the referral. Wow - did they have to hit us with F2F AND therapy reassessments at the same time??? :mad:

KateRN1 · Apr 16, 2011

Let's not even get started on therapy reassessments. I couldn't get appropriate intial assessments from therapists before this started, now I'm ready to start lynching, but not sure where to put the noose (most days, my own throat!).

paddler · Apr 17, 2011

What I don't understand is what's to keep a doc (who, let's face it probably doesn't actually read the stuff we send them for signature anyway) from just signing the FTF even if they have not seen the patient in 30 days? Having worked in the office, I know for a fact that 60% of papers are stamped with MD signature by the nurse, or if the doc does sign themn along with 1000 other documents that day, they are probably not reading it.

KateRN1 · Apr 25, 2011

Because the doc also has to fill out the F2F form, not just sign it. It forces them to document why the patient is receiving homecare rather than just blindly signing. But I know what you mean.

berube · Apr 26, 2011

has anyone had to discharge a patient yet because the F2F wasn't signed?

KateRN1 · Apr 26, 2011

We have 30 days from time of admission, so I don't think we'll see a problem until 4/30, which is only 4 days away. Not anticipating any at the moment.

HealthyNurse · May 4, 2011

What is your agency doing if the physician will not document the encounter (sends the form back blank, simply refuses to fill it out, etc.)?

KateRN1 · May 4, 2011

If hospitalist, take it up with the case management department. It's their job to make sure that referrals are completed, which includes the F2F encounter form.

If MD office referral, how on earth did you get the referral without the MD knowing that s/he had to sign the form? Beat the crap outta the marketer. LOL Seriously, in that case, explain to MD and/or office manager that patient will be discharged from needed homecare due to physician's lack of compliance, give HHABN to patient, discharge at day 30. Thankfully, have not run into that yet. Yet.