Home Health & Hospice Week

Physicians’ records need this documentation.

Not sure what medical reviewers will be looking for when they scan physicians’ records? Look at this list that the Centers for Medicare & Medicaid Services furnished in its 2015 HH PPS final rule for an idea.

“A physician will still be required to certify patient eligibility for the Medicare home health benefit” even though the face-to-face physician en-counter narrative requirement will be gone, CMS notes in the final rule published in the Nov. 6 Fed-eral Register. “Specifically for a certification of eligibility to be sufficient, a physician must certify that:”

• The individual needs or needed intermittent skilled nursing care, physical therapy, and/or speech language pathology services.
•  Home health services are or were required because the individual was confined to the home, except when receiving outpatient services.
• A plan for furnishing the services has been established and is or will be periodically reviewed by a physician who is a doctor of medicine, osteopathy, or podiatric medicine.
• Home health services will be or were furnished while the individual is or was under the care of a physician who is a doctor of medicine, osteopathy, or podiatric medicine.
• A face-to-face patient encounter occurred no more than 90 days prior to the home health start of care date or within 30 days of the start of the home health care, was related to the primary reason the patient requires home health services, and was performed by the certifying physician, a physician, with privileges, who cared for the patient in an acute or post-acute care facility from which the patient was directly admitted to home health, or an allowed NPP. The certifying physician must also document the date of the encounter as part of the certification.

Exception: “For instances where the physician orders skilled nursing visits for management and evaluation of the patient’s care plan, the certifying physician must include a brief narrative that describes the clinical justification of this need,” CMS adds. “The narrative must be located immediately before the physician’s signature. If the narrative exists as an addendum to the certification form, in addition to the physician’s signature on the certification form, the physician must sign immediately after the narrative in the addendum.”