Physician MUST Date Signature on Home Health & Hospice Certifications/Recertifications Effective Jan. 1, 2011

Provider Dating Receipt No Longer Acceptable

Effective Jan. 1, 2011, all Medicare home health and hospice certifications and re-certifications must be not only signed by the ordering physician, but also must be dated by that physician. During a conference call last week, the Centers for Medicare & Medicaid Services (CMS) advised its contractors of this interpretation of the final rule updating the home health prospective payment system for 2011 that was published in the Nov. 17 Federal Register.

According to CMS, this change will be effective for all claims submitted on or after Jan. 1, 2011. CMS referenced current policy manual citations, new home health regulations, and existing hospice regulations and manual citations as the basis for its authority. However, CMS failed to reference longstanding policy found in the home health plan of care instructions that permits fixing the date of receipt of signed orders in lieu of physicians dating their signatures.

The longstanding policy referenced by CMS is found in the Medicare General Information, Eligibility and Entitlement Manual (Pub. 100-01), Chapter 4, section 30.1, which states: “The attending physician signs and dates the POC/certification prior to the claim being submitted for payment.” This manual requirement will be put into regulation at 42CFR 424.22 (D)2: “The certification of need for home health services must be obtained at the time the plan of care is established or as soon thereafter as possible and must be signed and dated by the physician who establishes the plan,” and for re-certifications, “Recertification is required at least every 60 days, preferably at the time the plan is reviewed, and must be signed and dated by the physician who reviews the plan of care.”

Affixing the date of receipt in lieu of a physician’s dated signature has been CMS’ (then the Health Care Financing Administration’s, or HCFA’s) policy since the HCFA-485 was approved by the Office of Management and Budget in April 1987. Unfortunately, these plan-of-care instructions were deleted from the online Program Integrity Manual about a year ago and were never replaced.

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