Doctors' bad paperwork leads to $2B in inappropriate Medicare payments

Many physicians are failing to adequately document the face-to-face visits now required for home-health referrals, which has led Medicare to make $2 billion in inappropriate payments to home-health agencies, according to a report from HHS' Office of the Inspector General.

The Patient Protection and Affordable Care Act requires physicians to conduct in-person assessments to determine if a Medicare beneficiary is eligible for home care. Visits must be documented with a brief narrative that describes why the patient is homebound and requires skilled assistance at home.

A review of 644 face-to-face encounter documents from 2011 and 2012 uncovered that approximately one-third of physicians gave only vague descriptions of the patient's circumstances, or provided no documentation at all.

The OIG recommended that the CMS create a standardized form for face-to-face documentation, to ensure that physicians cover all required elements of their patient visits. The agency should also develop a strategy to communicate with physicians about the requirement, the OIG stated.

In a response to the report, the CMS said it would consider adopting a standardized form, but expressed concern that the approach would eliminate flexibility for physicians.

The CMS also plans to issue additional educational materials to physicians and strengthen its oversight of the policy.

Follow Virgil Dickson on Twitter: @MHvdickson