The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services, the primary enforcer of fraud and abuse prohibitions, posted Advisory Opinion No. 15-12 on August 13, 2015, which makes it clear that agencies may provide “introductory” or coordination visits to patients in their homes and elsewhere.
In this Advisory Opinion, a for-profit home health agency (HHA) provides services to patients whose care is paid for by the Medicare, Medicaid and other federal health care programs. According to the agency, a physician or a discharge planner/case manager presents a list of HHAs to patients who may benefit from home health services.
After patients choose agencies to provide services to them, physicians or discharge planners/case managers contact agencies chosen by patients to inform them of patients’ choices. The HHA has no involvement in the selection process and does not provide any remuneration to referral sources.
When the HHA receives referrals of patients, an employee of the HHA, called a “liaison,” contacts patients by telephone to see if they would like an initial visit with the liaison in their homes, called an “introductory” visit. When patients want such visits, they then choose whether they would like such visits in person, by telephone or by email. According to the OIG, in-person visits may occur in hospitals, physicians’ offices or in patients’ homes.
According to the HHA, the purpose of introductory visits is to facilitate patients’ transitions to home health in order to increase compliance with patients’ post-acute treatment plans. Consistent with this purpose, the liaison does the following during introductory visits:
Provides an overview of the home health experience
Gives patients written materials that include contact information for some of the HHA’s administrative and clinical staff
Shares pictures of members of the HHA’s clinical staff who will provide home health services
It is important to note that liaisons do not provide any type of diagnostic or therapeutic services reimbursed by federal health care programs during these visits and do not give patients any other items or materials.
Although the liaison in this case is a licensed practical nurse, the services provided by liaisons during introductory or coordination visits do not require any clinical training. Liaisons contact patients only after agencies receive referrals.
The HHA that requested the Advisory Opinion acknowledged that introductory or coordination visits are not covered services under the Medicare and Medicaid Program or any other third-party payors. The agency also stated that it does not submit claims for these services, does not include costs associated with these visits on its cost reports and does not shift the costs to any federal health care program, other payors or patients.
The OIG concluded that visits described above are permissible for the following reasons:
Patients receive only information about agency staff members, including photographs of patients’ care team members and an overview of the home health experience, so that the primary purpose of these activities it to facilitate patients’ transitions to home health services in order to improve compliance with post-acute treatment plans.
The OIG concluded that, although these visits may have some intangible worth to patients, they differ from other visits or assessments by health care providers that may constitute remuneration because the latter are reimbursable or provide services of more than nominal value to patients. The OIG also emphasized that fact that the agency received referrals of patients before introductory or coordination visits are made and the visits are a logical and reasonable first step in establishment of care relationships. Consequently, the OIG concluded that introductory or coordination visits do not constitute remuneration to patients and do not implicate either the anti-kickback or civil money penalties.
Elizabeth E. Hogue, Esq.