- Home Health Certifying Provider Change
- Home Health Aide Services and the Intermittent or Part-Time Rule
- Home Health Referrals
- Home Health Referrals
- Home Health Forms – Which is Required?
- Home Health Documentation Checklist
- Provider Compliance Tips for Home Health Services (Part A Non DRG)
- Eligibility Criteria for Face-to-Face Encounters
- Wound Care Under the Medicare Home Health Benefit
- Home Health Plans of Care: NPs, CNSs and PAs Allowed to Certify
- Homebound Status
- Home Health: The Definition of an Allowed Practitioner
- Medicare Home Health Benefit
- Home Health Certification Statement
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