- Avoiding Reason Code 38200
- Correcting Reason Code 37253
- Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)
- Billing the Home Health Period of Care Claim - PDGM
- Disposable Negative Pressure Wound Therapy Services Under Home Health
- Home Health Prospective Payment System Booklet
- Home Health Third Party Liability Demand Billing
- Home Health Demand Billing
- Notice of Admission Questions and Answers
- Billing the Home Health Notice of Admission Electronically
- Billing the Home Health Notice of Admission via DDE
- Home Health Transfers
- Home Health Agency Transfer and Dispute Protocol
- Late Notice of Admission - The Exception Process
- Reporting Home Health Periods with No Skilled Visits
- Telehealth Home Health Services: New G-Codes
- Reporting Site of Service Codes for Home Health Care
- PDGM Resources
- Billing G-Codes for Therapy and Skilled Nursing Services
- Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment
- Correcting and Avoiding Reason Code C7080: Inpatient Overlap
- Completing the Advance Beneficiary Notice for Home Health Agency Demand Claims
- The Medicare Home Infusion Therapy Benefit and Home Health Agencies
- Home Health Therapy Billing
- Home Health Billing When a New MBI is Assigned
- 30-Day Home Health Therapy Reassessment Schedule
Home Health Certifying Provider Change
Home health certifying physician or NPP changes can occur anytime for a variety of reasons. Some examples may include practitioner retirement or vacation and patient choice.
Regardless of the circumstance, if the recertifying physician or NPP is different from the certifying physician or NPP, HHAs are required to document in the medical record indicating they have ensured a different physician or NPP has been authorized to care for (including recertifying and signing the plan of care) the original certifying physician’s or NPP’s patients in their absence.
For example, if "Dr. A" signed the initial certification and "Dr. B" signed the recertification, the HHA should ensure and document that this has been authorized by “Dr. A”; however, there does not need to be written or signed documentation from the physician or NPP.
There is no designated format or form that must be used to show the change in provider. Documentation can be anything from the HHA that shows the HHA has confirmed the change(s) in certifying physician or NPP. HHAs are encouraged to include any documentation that support attempts to contact the original practitioner when changes occur.
Reviewers will confirm that all elements of the certification are included in the documentation sent for the recertification claim review. If the submitted certification documentation (submitted with the recertification documentation) does not support home health eligibility, the claim associated with the recertification period will not be paid.
Related Content
- Centers for Medicare & Medicaid Services, HHS § 484.60 — Condition of participation: Care planning, coordination of services, and quality of care (PDF)
- Code of Federal Regulations §424.22 Requirements for home health services
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 7 - Home Health Services
- CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 6 - Medicare Contractor Medical Review Guidelines for Specific Services
Posted 7/16/2024