In a recent Monday Minute, we addressed the latest government shutdown and the uncertainty it created across the healthcare landscape. Shortly after its release, a budget resolution was passed, officially restoring government operations. With that resolution came important updates that providers need to understand as they relate to Face-to-Face encounter requirements.
As part of that legislation, the allowance for conducting Face-to-Face encounters via telehealth for both home health and hospice was extended through December 31, 2027.
For home health, processes will continue as they have, and under the new final rule, agencies may accept Face-to-Face encounters from any qualified physician or non-physician practitioner, provided the encounter meets all required criteria.
Hospice, however, requires a closer look. Under this legislation, certain limitations have been placed on the use of telehealth for hospice Face-to-Face encounters.
The first restriction states that any hospice operating in a state subject to a federal moratorium would not be permitted to conduct Face-to-Face encounters via telehealth. At this time, however, there are no federal moratoriums in effect in any state in the United States, so this particular restriction does not currently impact any hospice providers.
There is some concern, however, following the recent visit by the new CMS Administrator to Los Angeles, where Dr. Oz raised the topic of moratoriums during discussions. In light of that, the legislation now includes a restriction on telehealth Face-to-Face encounters for hospices under federal moratoriums. This has led to concerns that federal moratoriums may be forthcoming.
The next restriction states that any hospice currently subject to Provisional Enhanced Oversight (PPEO) may not conduct Face-to-Face encounters via telehealth. Our understanding is that this applies to the individual hospice agency placed under PPEO, not simply to agencies operating in a state where PPEO guidelines exist.
In practical terms, this would typically apply to a hospice that is newly Medicare-certified, has undergone a change of ownership (CHOW) triggering PPEO, or was deactivated as a Medicare provider and later reactivated, resulting in placement under PPEO. At this time, PPEO restrictions are active in six states: California, Arizona, Nevada, Texas, Georgia, and Ohio.
The third restriction applies to every hospice nationwide. It requires that any telehealth Face-to-Face encounter be conducted by a physician or nurse practitioner who is registered in PECOS. Physicians identified on hospice claims as attending or referring providers have already been required to be enrolled in PECOS. However, the claims processing system does not verify whether a nurse practitioner listed on a claim was also enrolled in PECOS. Moving forward, agencies will be required to verify this for any NP that is conducting a Face-to-Face, even though this will only be validated by a reviewer if the chart is medically reviewed. Keep in mind that reviews can be initiated through ADRs, UPIC investigations, Medicare Administrative Contractors (MACs), SMRC audits, and other oversight entities. During those reviews, auditors will be checking to ensure that any physician or nurse practitioner conducting a telehealth Face-to-Face encounter for hospice is properly enrolled in PECOS.
With this Face-to-Face encounter requirement, verification would typically occur during a medical review. Keep in mind that reviews can be initiated through ADRs, UPIC investigations, Medicare Administrative Contractors (MACs), SMRC audits, and other oversight entities. During those reviews, auditors will be checking to ensure that any physician or nurse practitioner conducting a telehealth Face-to-Face encounter for hospice is properly enrolled in PECOS.
Finally, this is another provision that will affect every hospice in the country. Beginning January 1, 2027, claims will need to include a specific code indicating when the associated Face-to-Face encounter was conducted via telehealth.
At this time, we do not yet know what form that code will take, whether it will be an occurrence code, a condition code, or something else. Additional guidance is expected between now and January 1 to clarify those details. We are continuing to seek clear confirmation that our current understanding of these requirements is accurate. As soon as more definitive information becomes available, we will provide updates.
Healthcare Provider Solutions stands ready to assist any home health or hospice agencies with Face-to-Face Encounters or documentation of any kind. Should your agency need help, please reach out to us.
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