NewsLine - May 2013 - (Page 44)
Tip of the Month
Verbal Certification of
Terminal Illness
I
nadequate documentation of verbal
(or oral) certification of terminal
illness can be a reason for a denied
claim or negative audit outcome.
The Medicare hospice regulations require
that if the hospice provider cannot obtain
written certification of the terminal
illness within two calendar days of the
election of hospice services, it must obtain
verbal certification within that timeframe
instead. A written certification must then
be obtained and on file in the patient’s
record before the hospice can submit a
claim to its Medicare contractor.1
What Should It Cover?
Because the verbal certification is standing
in for the written certification, it must
contain certain information that is included
in the written certification, such as:
• A statement that the individual’s life
expectancy is six months or less if
the terminal illness runs its normal
course;
• The Benefit Period dates that the
certification or recertification covers;
• The name and credentials of the
physician who provided the verbal
certification;
• The name and credentials of the
hospice staff member receiving the
verbal certification.
The verbal certification should be obvious
in the clinical record. While there is no
official regulation that requires that it be
separate from a patent’s plan of care (e.g.,
the 485 form), CMS has stated that it is
their preference to see separation of these
two pieces of documentation.
Is It a Physician Order?
The Medicare hospice regulations do not
state if the verbal certification is a physician
order or that it requires a physician’s
signature. If a provider chooses to treat the
verbal certification as a physician order,
then the state regulations pertaining to
physician orders must be followed.
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.
44
NewsLine
Table of Contents for the Digital Edition of NewsLine - May 2013
Increasing Your Direct-from-Family Referrals
A Message From Don
Lighthouse of Hope Fund
The Advantages of Mobile Technology at the Bedside
Simione Consulting (display ad)
Revised State Hospice Profiles (display ad)
Dementia: A Closer Look
Differentiating Dementias
Spiritual Care for Patients With Dementia
NHF Gala Sponsors (display ad)
Make an Impact: African PC Nursing Scholarship (display ad)
ehospice USA Unveiled
Host a Screening of “Honor Flight, the Movie”
Two New Reports to Help You Evaluate Your Operations
New Report Released on Inpatient Hospital Deaths
Compliance Tip
New Online Courses from NHPCO’s E-OL
Videos Worth Watching
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