NAHC asserts that CMS violated Medicare law in three aspects
1. The
authorizing statute only requires that the physician document that the F2F
encounter occurred, not that the physician provides a narrative explaining why
a patient is home bound and in need of skilled care.
2. By
failing to provide adequate, reasonable and clear guidance on the standards for
compliance, CMS has failed to explain what constitutes ”sufficient”
narratives. This violates both the
United States Constitution and the Medicare Act.
3. Authorizing CMS’ contractors to solely use the
physician’s narrative to deny payments retroactively, without review of the entire patient record to determine
whether the patient is home bound and in need of skilled care is a further
violation of Medicare law.
NAHC has also sought a suspension of retroactive reviews of
physician narratives until CMS has revised its rules. NAHC has filed for
a preliminary injunction seeking expedited court review and will seek summary judgment, asserting that CMS does not
have authorization to require the physician narratives. Concurrently, NAHC
will work with members of Congress to seek a legislative remedy.
For further questions, please contact Charles MacKelvie at
(312) 235-1117 or cmackelvie@kdlegal.com or Meghan Linvill McNab at mmcnab@kdlegal.com or (317) 808-5863.