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The face to face encounter that the patient has with the physician is one of the most important criteria in qualifying a patient for home health services. If performed completely, it may alleviate the documentation burden that may arise later, and allow for a smooth delivery of home health services.
Conditions of the home health certifying face-to-face encounter:
1. Occurred no more than 90 days prior to or 30 days after home health admission
2. The reason for the face to face encounter must be related to the primary reason the patient needs home health services
3. Was performed by a physician or an allowed non-physician practitioner
4. The date of the encounter must be documented

*** Note ***
The primary diagnosis listed on the face to face encounter should be the etiological disease or the principal condition that is causing other diagnosis. If the patient has been dealing with the condition for some time then there must be an exacerbation in the condition for the encounter to trigger the home health benefit. Chronic conditions alone do not qualify patients for the home health benefit. There must be an acute exacerbation of a chronic condition for the patient to qualify for the home health benefit.
An example would be a patient with Diabetes Miletus or CHF for 10 years. Why would a patient with this chronic condition need home nursing or therapy services now? A possible reason would be the acute exacerbation of symptoms such as severe pain limiting function, shortness of breath limiting activities, severe muscle weakness causing difficulty in ambulation, or poor balance/falling.


The Home Health benefit defined


The Patient Driven Groupings Model