Certification and Recertification of Terminal Illness and Face-to-Face Encounters
Sets out who certifies and recertifies terminal illness, the federal timing rules and the separate Pennsylvania Medical Assistance timing rules, what each certification must contain including the physician's own narrative, how oral certifications are recorded, how face-to-face encounters are scheduled and attested before the third benefit period and each later one, when they may be done by telehealth, and what happens when a physician does not recertify.
About this policy
- Policy number
- PA-HSP-ELC-02
- Version
- 1.0
- Main rule
- 42 CFR §418.22
- Library
- Pennsylvania hospice · 60 policies
- Category
- Hospice care
- Sections
- 22
In short
- Every benefit period needs a written certification signed by a hospice physician; the first period also needs the attending physician if there is one.
- Agency standard: the written certification is signed by the second calendar day of each period. If only an oral certification is received, record it in the chart right away.
- The physician writes the narrative himself or herself, about this patient. Staff never draft it.
- From the third benefit period, a hospice physician or nurse practitioner sees the patient face to face within the 30 days before each recertification.
- Check with the clinical manager before any telehealth face-to-face visit: telehealth is not allowed in a moratorium area.
What's inside
22 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. Timing
- 7. What the Physician Considers
- 8. Content of Each Certification
- 9. Oral Certification
- 10. Face-to-Face Encounters
- 10.1 Scheduling
- 10.2 Attestation
- 10.3 Encounters by telehealth
- 11. When the Physician Does Not Recertify
- 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 the current benefit period. Who signed it, when, and does it include the benefit period dates?
- Where is the physician's narrative? Did the physician compose it and sign immediately below it?
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