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To comply with the Patient Protection Affordable Care Act, below is a sample of the required "Face--to-Face Encounter Attestation" to be completed, signed and dated by the physician. The face-to-face encounter is required 90 days prior to, or 30 days of, the start of home care services. The primary reason for home health services must be addressed during this encounter.

The encounter may be carried out by a nurse practitioner, a clinical nurse specialist, or a physician's assistant. S/he must document the clinical findings and communicate those findings to you. ONLY you, the physician, can complete the face-to-face encounter certification, sign and date the form.

The encounter must be documented on the home health plan of care addendum at the end of the "Home Health Certification and Plan of Care" form. The documentation must include:

  • The medical condition (diagnosis) which is the primary reason for home health care.
  • Your clinical findings supporting the need for home health care.
  • The date of the face-to-face encounter.
  • Based on your findings, the home health services that are medically necessary for the patient.
  • Your clinical findings supporting the patient is essentially homebound and the reason for the patient being homebound.
  • Your signature, date, and printed name at the end of this attestation format.

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Face-to-Face Encounter