Certification and Recertification by Physicians for Hospice Care

60 - Certification and Recertification by Physicians for Hospice Care (Rev. 68, Issued: 04-22-11, Effective: 01-01-11, Implementation: 05-12-11)) The hospice must obtain written certification of terminal illness for each period of hospice care received by an individual. For the initial 90-day period, the hospice must obtain written certification statements from the medical director of the hospice or the physician member of the hospice interdisciplinary group, and the individual's attending physician (if the individual has one). The certification must specify that the individual's prognosis is for a life expectancy of 6 months or less if the terminal illness runs its normal course. Recertification for subsequent periods only requires the written certification by the hospice medical director or the physician member of the hospice interdisciplinary group. Certifications and recertifications must be dated and signed by the physician and must include the benefit periods to which they apply. Certifications and recertifications must include a brief narrative explanation of the clinical findings that supports a life expectancy of 6 months or less. If written certification is not obtained within 2 calendar days of the initiation of hospice care, a verbal certification must be obtained within the 2 days. A written certification from the medical director of the hospice or the physician member of the interdisciplinary group must be on file in the beneficiary's record prior to the submission of a claim to the Medicare contractor. If these requirements are not met, no payment may be made for the days prior to certification. Instead payment will begin with the day certification is obtained, i.e., the date verbal certification is obtained. Certifications and recertifications may be completed up to 15 days before the next benefit period begins. For recertifications on or after January 1, 2011, a hospice physician or hospice nurse practitioner must have a face-to-face encounter with each hospice patient prior to the beginning of the patient’s third benefit period, and prior to each subsequent benefit period. Failure to meet the face-to-face encounter requirements results in a failure by the hospice to meet the patient’s recertification of terminal illness eligibility requirement. The patient would cease to be eligible for the benefit. See Pub. 100-02, Medicare Benefit Policy Manual, Chapter 9, Section 20.1, Timing and Content of Certification.