Home Health & Hospice Week

Are you risking denials with records that include an insufficient physician recertification estimate - or no estimate at all? Use one MAC's advice to combat the reimbursement-draining problem.

Reminder: For a home health recert, "the physician must include an estimate of how much longer the skilled services will be required," HHH Medicare Administrative Contractor CGS says in a recent post on its website. "The physician's recertification estimate should be included on the recertification document along with other required elements of the recertification and not on any separate form or order. Most often the physician recertification statement is found on the Plan of Care/485."

Advice: "If the physician recertification estimate is not included in the same box/locator as the remainder of the recertification statement: Ensure visibility by placing on a distinct and separate line; Draw the reviewer's attention by denoting the statement with brackets, such as [ ] or { }, asterisks (*) or underline the text" - although "highlighter is not recommended;" and "utilize verbiage that clearly indicate the statement is the physician's recertification 'estimate.'"

CGS offers these examples of estimates that are acceptable: "I estimate John Doe will qualify for home health services for another 15 days; I estimate John Doe will qualify for home health services for another 4 weeks;" and "I estimate John Doe will qualify for home health services until October 1, 2017."

On the other hand, CGS cites these examples of what physicians should NOT write: "The patient will be on our services until the patient can walk safely" and "The patient will need home care until the wound heals."