Limitation on Physician Signatures who have a financial relationship with the HHA

Originally published by kennedyhealthlaw.

If a physician has a financial relationship with a HHA, that physician is limited , and may not sign plans of care, certifications, or recertifications unless the financial relationship meets certain exceptions.

The exceptions are found in 42 C.F.R. §411.355-§411.357.  These exceptions are very similar to the Anti-kickback exceptions and will allow a medical director to furnish medical director (personal services) services to the HHA.  However, the exception has several prongs, and if you fail to meet them all, any signature your medical director puts on a plan of care, certification, or recertification, may be void, and ultimately, the payment for the home health services provided under that void certification or void plan of care will also be void, and CMS will request the repayment of it.
Before you accept your medical director’s signature on a Plan of Care, a certification or recertification, make certain your medical director’s signature will not be void due to the financial relationship he/she has with your agency.

In MLN Matters 1436 Special Edition, CMS plainly states that the face-to-face encounter cannot be performed by any physician or allowed Nurse practitioner who has a financial relationship with the HHA.  CMS mentions no caveats or exceptions in this part (page 4), and references section 424.22(d)(2) which is the regulation prohibiting a nurse practitioner from completing any form a physician would not be allowed to complete.  While it might be a stretch to go from disallowing a nurse practitioner’s signature to disallowing the physician for the same (d)(2) section, CMS does not equivocate when prohibiting the physician’s signature on the face-to-face form if the physician has a financial relationship with the HHA.

This MLN Matters 1436 does not except when the physician with the financial relationship is performing the F2F for his/her own patients. This prohibition would curtail any physician, PA, or NPP from performing the F2F if the physician has a financial relationship with the HHA.

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