Physicians Certification
What Is A Physician Certification For Hospice?
- A statutory requirement as indicated in the Social Security Act, Section 1814(a)(7)(A)
- The physician certifies that the beneficiary has a medical prognosis that his/her life expectancy is six months or less if the terminal illness runs its normal course
- Each physician certification should coincide with the start of a new benefit period
What Must Be Included In A Hospice Physician Certification?
- A “prognosis statement” that the beneficiary has a life expectancy of six months or less if the terminal illness runs its normal course
- Physician’s signature(s) and date of signature(s)
- Sufficient documentation supporting the basis for certification
- Must accompany the certification and be filed in the patient’s medical records
- It is recommended that the benefit period be referenced
When Must A Hospice Physician Certification Be Obtained?
- At the beginning of each benefit period
- Written certification signed and dated by physician(s) no later than 2 days from start of the benefit period
- Verbal certification, if unable to obtain the physician’s written certification. If initial, must be signed and dated by both physicians no later than 2 days from start of the benefit period
Who Must Sign The Initial Certification?
- The initial certification must be signed by the Medical Director of the hospice, or a physician member of the Interdisciplinary Group (IDG), and the beneficiary’s attending physician
- Document if the hospice’s medical director is also acting as the attending physician
When Must A Verbal Certification Be Obtained?
- Only required if unable to obtain a physician written certification within 2 days after start of the benefit period
- Obtain from hospice medical director, or a physician member of the IDG, and beneficiary’s attending physician if initial certification
What Elements Must Be Included In A Verbal Certification?
- Physician name(s) – 2 required if initial certification
- Admitting diagnosis
- Beneficiary name
- Start of care date
- Prognosis statement
- Name of person receiving the verbal certification and the date received
- It is suggested that the title of the person receiving the verbal certification be included
When Must A Verbal Certification Be Signed?
- Physician(s) must sign and date the verbal certification prior to billing Medicare for services
What are the Recertification Requirements?
- Signature and date needed from hospice medical director, or physician member of IDG within 2 days of the new benefit period
- Prognosis statement
- Supporting documentation of basis for certification
- Start date of new benefit period