Albemarle Home Care
Albemarle Hospice
SERVING NORTHEASTERN NORTH CAROLINA SINCE 1968
NEW REQUIREMENT FOR ALL MEDICARE PATIENTS TO RECEIVE HOME
HEALTH SERVICES
Effective 4/1/2011
1.
Each patient must have a face-to-face (F2F) encounter with a physician within 90 days prior to, or
within 30 days of, the start of home health.
2. The patient’s F2F encounter with the physician must be related to the primary reason for which the
patient requires home health services.
3. In order for the Home Health Agency to bill Medicare, the agency must have documentation of the
face to face encounter by the physician.
4. The physician’s documentation of the face-to-face encounter must include:
 The date of the encounter
 Indication that the encounter was related to the primary reason for home health
 An explanation of how the clinical findings of the encounter support the need for skilled
nursing or therapy services
 An explanation of why the clinical findings of the encounter support that the patient is
homebound
 Physician’s signature, and date of that signature
5. It is acceptable for the certifying physician to dictate the documentation content to one of the
physician’s support personnel to type.
6. It is acceptable for the documentation to be generated from a physician’s electronic health record.
7. It is unacceptable for the physician to verbally communicate the encounter to the HH Agency, and
for the HH Agency to document the encounter for the physician to sign.
8. A nurse practitioner, a clinical nurse specialist, or a physician’s assistant may conduct the face-toface encounter as long as there is documentation of their clinical findings, and it is communicated to
the physician. However, only a physician may order home health services, certify that a face-to-face
encounter occurred, and certify that other eligibility criteria are met (medical necessity and
homebound status).
Albemarle Home Care  Albemarle Hospice  CAP-DA Case Management  DayBreak
P.O. Box 189, 311 Cedar Street, Elizabeth City, NC 27907-0189  252-338-4066  800-478-0477  FAX 252-338-4364
Albemarle Home Care
Documentation of Face to Face
Encounter for MEDICARE Patients
1. Patient Name and Identification:
_________________________________________________________________________
2. I certify that this patient is under my care and that I, or a nurse practitioner or physician’s assistant
working with me, had a face-to-face encounter that meets the physician face-to-face encounter
requirements with this patient on: (Insert date that visit occurred):
_________________________________________________________
Month
Day
Year
3. The encounter with the patient was in whole, or in part, for the following medical condition, which is the
primary reason for home health care (List medical condition):
________________________________________________________
4. I certify that, based on my findings, the following services are medically necessary home health services
(Check all that apply):


Nursing
Physical therapy


Occupational Therapy
Speech Language Pathology
5. My clinical findings support the need for the above services because:
_______________________________________________________________________________________
_______________________________________________________________________________________
__________________________________________________________________
6. Further, I certify that my clinical findings support that this patient is homebound (i.e. absences from
home require considerable and taxing effort and are for medical reasons or religious services or
infrequently or of short duration when for other reasons) because:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Physician Signature: ____________________________________________ Date: ____________
Physician Printed Name: _________________________________PH/FAX #:_________________
Return to: Albemarle Home Care, 311 Cedar St., Elizabeth City, NC 27909
Fax: (252) 338-4069
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