Home Health & Hospice Week

Do your own review, before lackluster certs lose you reimbursement.

Will your physician certifications of terminal illness keep your reimbursement flowing? If not, you may be in for trouble as scrutiny of this area intensifies.

The HHS Office Of Inspector General found problems with 14 percent of the certs it examined in a recent review (see related story, p. 273). To avoid medical review problems, make sure the physician narrative:

1. is there at all. About 10 percent of claims reviewed by the OIG lacked a narrative altogether, or the narrative included only the patient’s diagnosis, the OIG notes in its report. Make sure it’s present.

2. includes clinical findings. Your patient’s narrative must explain the clinical findings, the OIG says in the report. “It must reflect the beneficiary’s individual clinical circumstances and cannot include checkboxes or standard language used for all patients.”

3. contains an attestation statement. “The narrative must include an attestation confirming that the physician wrote the narrative based on either an examination of the patient or a review of the clinical record,” the OIG reminds in the report. “For the third and subsequent periods, the beneficiary must be examined face-to-face by either a physician or a nurse practitioner.”

Tip: Don’t overlook the importance of educating your certifying physicians on cert requirements, the National Hospice & Palliative Care Organization says. A study the NHPCO reported in its July 2012 newsletter found better cert compliance when physicians trained other physicians on how to document properly.

Check yourself: Assess your ongoing cert compliance, and improvement, with a quality assurance initiative focused on the topic, the NHPCO article suggested.