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Certification and Recertification of Terminal Illness and Face-to-Face Encounters

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.

Preview: full text with a package
About this policy
Policy number
NC-HSP-ELC-02
Version
1.0
Main rule
42 CFR §418.22
Library
North Carolina hospice · 60 policies
Category
Hospice care
Sections
19

In short

  • 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.

What's inside

19 sections. The full text comes with the One-time Policy Pack.

Full text with a package
  • 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

An inspector may ask

  • 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?

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