5CFTF - Face-to-Face Encounter Requirements Not Met

The services billed were not covered because the documentation submitted for review did not include documentation of a face-to-face encounter.

How to prevent this denial

The face-to-face encounter must occur no more than 30 calendar days prior to the start of the third benefit period and no more than 30 calendar days prior to every subsequent benefit period thereafter.

Specific documentation related to the face-to-face encounter requirements must be submitted for review. This includes, but is not limited to, the following:

• The hospice physician or nurse practitioner who performs the encounter must attest in writing that he or she had a face-to-face encounter with the patient, including the date of the encounter
• The attestation, its accompanying signature, and the date signed must be a separate and distinct section of, or an addendum to, the recertification form, and must be clearly titled
• When a nurse practitioner performs the encounter, the attestation must state that the clinical findings of that visit were provided to the certifying physician for use in determining whether the patient continues to have a life expectancy of six months or less, should the illness run its normal course

For more information refer to:

• CMS Internet-Only Manuals (IOMs), Publication 100-02, Medicare Benefit Policy Manual Chapter 9, Section 20 (PDF, 639 KB)