Q: Are denials related to Physician’s Certifications common, and how can we avoid them?
A:According to the latest Comprehensive Error Rate Testing report from the Centers for Medicare & Medicaid Services, inadequate documentation for Physician’s Certifications/Recertifications accounted for over 35% of errors contributing to improper payments. No specific form is mandated, but the documentation must include all required components, be timely and be signed and dated by a physician or nonphysician provider.
Certification:
• The individual needs skilled nursing or rehabilitation services
• Services are required daily (or five days a week for therapy)
• Services can only be provided in the SNF
• Services are for an ongoing condition for which the individual received inpatient hospital care or arose during a SNF stay
Recertification:
• Reason for continued post-hospital SNF care
• Estimated time to remain in the SNF
• Discharge or home care plans
• Whether continued SNF services are for a condition that was treated or arose during the SNF stay
Timing:
• Certification must be obtained at admission or as soon as reasonable
• First recertification is required by the 14th day of post-hospital SNF care
• Subsequent recertifications are required at least every 30 days
There may be times of isolated oversight or lapse. In rare instances, delayed certs/recerts will be honored with an explanation or other relevant evidence.
From the July/August 2022 Issue of McKnight's Long-Term Care News
