{"ref":"NC-HSP-ELC-02","title":"Certification and Recertification of Terminal Illness and Face-to-Face Encounters","category":"Hospice care","summary":"Sets how the Agency obtains written (and when needed oral) certification of terminal illness for every benefit period, who may certify, the physician narrative and signatures, the face-to-face encounter before the third and each later benefit period (including the limits on telehealth encounters), and the NC Medicaid prior approval with clinical review for third and later periods.","inShort":["Every benefit period needs a written certification from a hospice physician before billing.","If the written one is late, get an oral certification within 2 calendar days and note it in the record at once.","Only the physician writes the narrative. Never draft it or use standard wording.","From the third benefit period, a hospice physician or nurse practitioner sees the patient in the 30 days before recertification.","Telehealth visits need Medical Director approval and a check that no moratorium or other exception applies.","NC Medicaid third and later periods: send the prior approval papers at least 10 days before the period ends."],"primaryCitation":"42 CFR §418.22","citations":["G.S. 131E-201(4)","10A NCAC 13K .0102(17)","NC Medicaid Clinical Coverage Policy 3D, sections 5.1, 5.2.2.1, 5.2.2.2, 5.4"],"federalCitations":["42 CFR §418.22","42 CFR §418.25(b)","42 CFR §418.102(b), (c)","42 CFR §418.21","42 CFR §418.104(a)(5)"],"surveyorAsks":["Show me the certification for each benefit period for this patient. Who signed, and when?","Where is the physician's narrative, and did the physician write it for this patient?"],"forms":[{"ref":"NC-HSP-ELC-02-A","title":"Certification of Terminal Illness and Face-to-Face Attestation"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §418.22)","5. Timing","6. Who Certifies","7. Content of the Certification","8. Face-to-Face Encounters","8.1 Telehealth face-to-face encounters","9. NC Medicaid Prior Approval for Benefit Periods","10. Tracking and IDT Review","11. Responsibilities","12. Records and Compliance Monitoring","13. Staff Training","14. References","15. Related Policies and Forms","16. Approval","17. Revision History"],"version":"1.0","sample":false,"pack":"nc-hospice","state":"North Carolina","service":"Hospice","guides":[{"path":"/guides/hospice-policies/","h1":"What policies are required for hospice?"},{"path":"/guides/hospice-conditions-of-participation/","h1":"Hospice Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}