Certification and Recertification of Terminal Illness and Face-to-Face Encounters
Sets out who certifies and recertifies that a patient is terminally ill, the time frames (certifications no more than 15 calendar days before the effective date of election, recertifications no more than 15 calendar days before the next benefit period, oral certification within 2 calendar days if the written one is not yet obtained), the content of the certification and the physician's own narrative, the face-to-face encounter before the third benefit period and every later one (no more than 30 calendar days before), the current telecommunications rules, the Michigan duty to validate and record the terminal prognosis, and the Michigan Medicaid requirements.
- Policy number
- MI-HSP-ELC-02
- Version
- 1.0
- Main rule
- 42 CFR §418.22
- Library
- Michigan hospice · 59 policies
- Category
- Hospice care
- Sections
- 19
In short
- Every benefit period needs a written certification signed by the right physician before billing.
- The physician writes the narrative about this patient. Staff never draft it and never use check boxes or standard wording.
- If the written certification is not in within 2 days after a period starts, get an oral one and write it in the record right away.
- From the third benefit period, a hospice physician or nurse practitioner must see the patient within the 30 days before the period starts. Schedule it early.
- Watch the benefit period report. Tell the director of nursing at once if a recertification or visit is at risk of being late.
What's inside
19 sections. The full text comes with the One-time Policy Pack.
- Terms of Reference
- 1. Purpose
- 2. Scope
- 3. Definitions
- 4. Policy Statement (42 CFR §418.22)
- 5. Who Certifies
- 6. Time Frames
- 7. Content of the Certification and the Narrative
- 8. Face-to-Face Encounters
- 9. Oral Certifications and Filing
- 10. Tracking Benefit Periods
- 11. When a Physician Will Not Recertify or an Encounter Is Missed
- 12. Responsibilities
- 13. Records and Compliance Monitoring
- 14. Staff Training
- 15. References
- 16. Related Policies and Forms
- 17. Approval
- 18. Revision History
An inspector may ask
- Show me the certification for this patient's current benefit period. Who signed it and when?
- Where is the physician's narrative? Is it written for this patient?
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