Wednesday, September 3, 2014

CMS Revises SNF Certifications and Recertification MLN Article

Dianne De La Mare

The US Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) has recently updated its Medicare Learning Network (MLN) Article SE1428, Comprehensive Error Rate Testing (CERT): SNF Certifications and Recertifications, which alerts SNFs that a major reason for denial of claims is failure to obtain certification and recertification statements from physicians or non-physician practitioners (NPPs). The routine admission order established by a physician is not a certification of the necessity for post hospital extended care services, according to CMS.

 An acceptable certification statement must contain:
• The individual needs skilled nursing care or other skilled rehabilitation services;
• Such services are required on a daily basis;
• Such services can only practically be provided in a SNF or swing-bed hospital on an inpatient basis;
• Such services are for an ongoing condition for which the individual received inpatient care in a hospital; and
• A dated signature of the certifying physician or NPP.

An acceptable re-certification statement must contain:
• The reasons for the continued need for post hospital SNF care;
• The estimated time the individual will need to remain in the SNF;
• Plans for home care, if any;
• If the reason for continued need for services is a condition that arose after admission to the SNF this must be indicated; and
• A dated signature of the recertifying physician or NPP.

To obtain a complete copy of the MLN Article go to http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1428.pdf.

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