Physician 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

Any further questions contact Carolina Hospice Care at 877-849-5910

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