Medicare Compliance & Reimbursement

Nursing homes don't need to repeat the same mistakes.

If long-term care providers aren't certain their processes for physician certification and recerts for skilled nursing care are top-notch, they can quiz themselves now to get ready for this regulatory hot spot.

Failing to do so could cost a facility thousands in denied claims, cautions Betsy Anderson of Frost, Ruttenberg & Rothblatt in Deerfield, IL.

Brush up on these answers to commonly asked questions about certification basics:

1. Do we need to use a specific form?

No. How you document physician certification and recerts is up to you. The Medicare Program Integrity Manual clearly states the providers are free to enter certification or recertification statements "on forms, notes or records that the appropriate individual signs, or on a special, separate form."

2. What exactly constitutes a complete physician certification?

Surprisingly, not all providers know. One fiscal intermediary, Mutual of Omaha, recently reminded providers "routine admission orders made by the physician are not a certification for SNF necessity for the purposes of the Medicare program." Rather, a separate signed statement must indicate that the patient will require daily SNF-covered care.

Furthermore, a complete certification should be made on or before day 14 of the SNF stay. The feds require subsequent recertifications for skilled care at least every 30 days thereafter.

3. Who can sign?

A physician, nurse practitioner or clinical nurse specialist who is responsible for the resident - and who is not an employee of the SNF or a related organization - can sign both certifications and recertifications for skilled care, notes Linda Black-Kurek, president of LBK Health Care Inc. in Dayton, OH.