NewsLine - April 2013 - (Page 32)

Tip of the Month Physician Certification and Recertification Narratives T he physician’s brief narrative was added to Medicare’s hospice certification/recertification process, effective October 1, 2009. The narrative should contain an explanation of the clinical findings that support a life expectancy of six months or less as part of the certification and recertification forms, or as an addendum to the forms. NHPCO recommends that the hospice medical director or hospice physician compose the narrative at initial certification and at recertifications thereafter to ensure it provides the most complete and up-to-date information. The following requirements must be met for regulatory compliance: • If the narrative is part of the certification or recertification form, then it should appear immediately above the physician’s signature. • If the narrative exists as an addendum to the certification or recertification form, the physician’s signature must appear immediately after the narrative in the addendum (as well as on the certification or recertification form). • The narrative should include a statement (directly above the physician’s signature) attesting that, by signing, the physician confirms that he or she composed the narrative based on his or her review of the patient’s medical record or, if applicable, his or her examination of the patient. 32 NewsLine • The narrative must reflect the patient’s individual clinical circumstances and cannot contain check boxes or standard language used for all patients. • The physician must synthesize the patient’s comprehensive medical information in order to compose the narrative. For example, it should contain applicable prognostic indicators, symptom management scale scores, and functional scales scores. (“Refer to history and physical” is not an appropriate narrative statement.) • For recertifications on or after January 1, 2011, the narrative associated with the third-benefitperiod recertification and every subsequent recertification must include an explanation of why the clinical findings of the face-to-face encounter support a life expectancy of six months or less. Finally, hospice providers should be reviewing physician narrative statements on a regular basis as part of their QAPI activities. Medicare Administrative Contractors will deny a claim based on the content of the physician narrative statement. A problem with the certification/recertification documentation also affects billing for the entire benefit period. References: CMS, Medicare Benefit Policy Manual, Chapter 9: Coverage of Hospice Services Under Hospital Insurance; 20.1 Timing and Content of Certification, 3-23-11.

Table of Contents for the Digital Edition of NewsLine - April 2013

New Research Validates That Hospice Saves Medicare Big Dollars
A Message From Don
NHPCO HAN’s Advocacy Strategy for the Hill
Simione Consulting (display ad)
Hospice Education Network (display ad)
Fraud and Abuse
Make an Impact: African PC Nursing Scholarship Fund (display ad)
Honoring Our Four-Legged Volunteers
Creating a Volunteer-Inclusive Culture
Do Your Colleagues Know They’re NHPCO Members Too?
New—Lighthouse of Hope Fund
R2R: Helping Hospice Staff Raise Needed Funds
A Great Resource for Your Referral Partners
Revised State Hospice Profiles (display ad)
NHPCO’s HPC Professional Scholarship Program (display ad)
Member News and Notes
Compliance Tip of the Month
Videos Worth Watching

NewsLine - April 2013