Updates are being made to AmeriHealth medical policies for face-to-face encounter requirements for home health and durable medical equipment (DME) services, as detailed in this article. If you have any questions regarding these medical policy updates, please contact your Network Coordinator or Hospital/Ancillary Services Coordinator.

Home health services

Effective July 22, 2014, Medical Policy #02.01.01c: Home Health Care Services will be updated to include the requirement of a face-to-face encounter by the certifying professional provider prior to certifying a member's eligibility for home health care services. Therefore, new requirements regarding the face-to-face encounter will be included in the policy. Prior to certifying an individual's eligibility for home health care services, the certifying professional provider must document that (1) a face-to-face encounter has occurred with the member, either with the certifying professional provider or another professional provider and (2) the following requirements are met: The face-to-face encounter occurred within 90 days prior to, or within 30 days after, the start of home health care. In situations where a professional provider is ordering home health care for the member involving a new condition that was not evident during an encounter within 90 days prior to the start of home care, the certifying professional provider must see the individual within 30 days after the start of home health care services. Please visit our Medical Policy Portal to review the notification for Medical Policy #02.01.01c: Home Health Care Services in its entirety.

DME services

AmeriHealth requires that DME providers include documentation for detailed written orders for face-to-face encounters conducted by professional providers for specific DME items and their associated codes. As a result, the following will be included in applicable DME-related medical policies: Documentation of a face-to-face encounter between the treating professional provider and the individual meeting the requirements listed in the medical policy, including an assessment of the individual's clinical condition supporting the need for the prescribed DME item(s), must be provided to and kept on file by the DME supplier. The face-to-face encounter requirement ensures that the orders and certification for DME are based on a professional provider?s current knowledge of the individual?s clinical condition. This requirement is consistent with the Centers for Medicare & Medicaid Services' face-to-face encounter requirements for covered DME items. Go to our Medical Policy Portal for more information about our documentation requirements for DME services.