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Run: Home Health Face-to-Face Encounter Documentation

Home Health Face-to-Face Encounter Documentation captures the practitioner visit that supports homebound status and skilled need for home health certificatio...

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Encounter Timing and Patient Context

Patient Identifier (required)

Use the internal medical record number or other organization-approved identifier. Do not enter SSN.

Start of Care Date (required)

Date home health services started.

Face-to-Face Encounter Date (required)

Date of the qualifying face-to-face encounter. It must be no more than 90 days before or within 30 days after the start of care date.

Does the encounter fall within the required timing window? (required)

Confirm the encounter occurred within 90 days before or within 30 days after start of care.

Certifying Practitioner Information

Practitioner Role (required)

Select the physician or allowed practitioner type.

Practitioner Name (required)

Enter the practitioner name for the audit trail.

NPI (required)

Enter the 10-digit National Provider Identifier.

Practice Setting

Select the setting where the encounter occurred.

Encounter Narrative

Encounter Summary (required)

Briefly summarize the reason for the encounter, relevant findings, and why home health is needed.

Homebound Status Support (required)

Describe the specific limitations that make leaving home a considerable and taxing effort, and any assistance required to leave the home.

Skilled Need Support (required)

Describe the skilled nursing, therapy, or other skilled services needed and why they require professional care.

Documentation and Attestation

Supporting Documentation Attached

Select any supporting records included with this submission.

Yes No N/A

Practitioner Attestation (required)

Required attestation for compliance documentation.

Yes No N/A

Practitioner Signature (required)

Electronic signature of the certifying physician or allowed practitioner.

Signature Date (required)

Date the practitioner signed the documentation.

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