Content of the Physician Certification

30.1 - Content of the Physician Certification (Rev. 10757; Issued: 05-11-21; Effective: 03-01-20; Implementation: 08-11-21) Under both the hospital insurance and the supplementary medical insurance programs, no payment can be made for covered home health services that a home health agency (HHA) provides unless a physician or allowed practitioner certifies that: • Home health services are needed because the individual is confined to his/her home; • The individual needs intermittent skilled nursing care, physical therapy and/or speech-language pathology services. Where a patient’s sole skilled service need is for skilled oversight of unskilled services, the physician or allowed practitioner must include a brief narrative describing the clinical justification of this need as part of the certification, or as a signed addendum to the certification; • A plan for furnishing such services to the individual has been established and is periodically reviewed by a physician or allowed practitioner; • The services are or were furnished while the individual was under the care of a physician or allowed practitioner; and • The individual had a face-to-face encounter with a physician or an allowed non- physician practitioner no more than 90 days prior to or within 30 days after the start of home health care and the encounter was related to the primary reason the patient requires home health services in accordance with requirements described in Pub. 100-02, Medicare Benefit Policy Manual, chapter 7, section 30.5.1.1. The certifying physician or allowed practitioner must also document the date of the encounter. Certifications must be obtained at the time the plan of care is established or as soon thereafter as possible. The physician or allowed practitioner must sign and date the plan of care (POC) and the certification prior to the claim being submitted for payment; rubber signature stamps are not acceptable. The plan of care may be signed by another physician or allowed practitioner who is authorized by the certifying physician or certifying allowed practitioner who established the plan of care, to care for his/her patients in his/her absence. The HHA is responsible for ensuring that the physician or allowed non- physician practitioner who signs the plan of care and recertification statement was authorized by the physician or allowed practitioner who established the plan of care and completed the certification for his/her patient in his/her absence. While the regulations specify that documents must be signed, they do not prohibit the transmission of the POC, oral order, or certification via facsimile machine. The HHA is not required to have the original signature on file. However, the HHA is responsible for obtaining original signatures if an issue surfaces that would require verification of an original signature. Home health agencies that maintain patient records by computer rather than hard copy may use electronic signatures. However, all such entries must be appropriately authenticated and dated. Authentication must include signatures, written initials, or computer secure entry by a unique identifier of a primary author who has reviewed and approved the entry. The HHA must have safeguards to prevent unauthorized access to the records and a process for reconstruction of the records upon request from the Medicare contractor, state surveyor, or other authorized personnel, in the event of a system breakdown. See §10.1 for the effects of failure to certify or recertify.