Home Health & Hospice Week

Warning: Vague statements about length of service won't cut it.

Question: How can we make sure the recertification requirement to include an estimate of how much longer a patient's skilled services are required is fulfilled?

Answer: Medicare regulations are clear: "The physician must include an estimate of how much longer the skilled services will be required" in the recert, HHH Medicare Administrative contractor CGS says in its May provider bulletin. "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," CGS instructs.

"Most often the physician recertification statement is found on the Plan of Care/485," CGS continues.

But if it's not included "in the same box/locator as the remainder of the recertification statement," HHAs can take these steps to avoid a denial:

• Ensure visibility by placing the estimate 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;
• "Utilize verbiage that clearly indicate the statement is the physician's recertification 'estimate.'"

Watch out: "Highlighter is not recommended," CGS adds.

Urge Docs To Get Specific

If your physicians are having trouble crafting a valid estimate statement, offer them these examples from CGS as a model:

      * 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.
      * I estimate John Doe will qualify for home health services until October 1, 2017.

Conversely, here are two examples of what they should not say: "The patient will be on our services until the patient can walk safely" or "The patient will need home care until the wound heals."

Note: See the article at www.cgsmedicare.com/hhh/pubs/mb_hhh/2018/j15_hhh_05-18.pdf.