Home Health Care: Proper Certification Required per CMS

The Affordable Care Act requires a physician or a non-physician practitioner to have a face-to-face encounter with the beneficiary before a physician certifies the beneficiary’s eligibility for the home health benefit. One aspect of the certification is for the certifying physician to certify (attest) that the face-to-face encounter occurred and document the date of the encounter. For medical review purposes, Medicare requires documentation in the certifying physician’s medical records and/or the acute/post-acute care facility’s medical records to be used as the basis for certification of patient eligibility. This documentation must include the clinical note or discharge summary for the face-to-face encounter. Avoid home health claims payment denials or improper payment recoveries by understanding Medicare’s requirements.

Resources:

• CY 2015 Home Health Prospective Payment System Final Rule
• Medicare Benefit Policy Manual, Chapter 7, Section 30.5.1
• National Provider Call: Certifying Patients for the Medicare Home Health Benefit

MLN Matters® Articles:

• Certifying Patients for the Medicare Home Health Benefit
• Manual Updates to Clarify Requirements for Physician Certification and Recertification of Patient Eligibility for Home Health Services