Liability questions arise over home care referrals
Certification of need at center of issue
The home care industry has launched a national education campaign to bring providers up to speed on the Health Insurance Portability and Accountability Act (HIPPA) because of physician concerns about potential liability. The focal point of this effort is a memo on potential physician liability when certifying a Medicare home health care patient plan of care prepared by the National Association for Home Care (NAHC).
The NAHC memo acknowledges that, under HIPPA, physicians are now subject to civil and financial penalties if they certify in a plan of care that a patient meets Medicare coverage qualifications when, in fact, they know the patient does not qualify.
According to NAHC, physicians only face problems if they know a patient does not meet Medicare benefit qualifications for home care but still certify that those qualifications are met.
Any "unintentional error in the physician certification or a matter where there is a possibility of professional disagreement does not constitute a circumstance, which meets the test of knowing,’" says NAHC.
"The Medicare program would be required to establish that not only does the patient fail to meet Medicare coverage qualifications, but also that the physician knew that the patient’s needs did not meet those qualifications and still certified the care as necessary for a patient confined to the home," maintains the memo.
In short, physicians are not subject to sanctions if, in good faith, they certify that a Medicare patient needs home health services, says the association.
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