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Proposed Changes Regarding Certification, Recertification and Remote Monitoring

Posted on Thursday, August 9, 2018 3:29 PM

CMS has issued its calendar year 2019 home health prospective payment system (HHPPS).  In addition to payment updates, CMS is proposing changes to certifying and recertifying patient eligibility for Medicare home health services and remote monitoring under the home health benefit.

CMS is proposing to revise the regulation at §424.22 (c) to read as follows:

(c) Determining patient eligibility for Medicare home health services. (1) Documentation in the certifying physician’s medical records or the acute/post-acute care facility’s medical records (if the patient was directly admitted to home health) or both must be used as the basis for certification of the patient’s eligibility for home health as described in paragraphs (a)(1) and (b) of this section. Documentation from the HHA may also be used to support-the basis for certification of home health eligibility, but only if the following requirements are met:

(i) The documentation from the HHA can be corroborated by other medical record entries in the certifying

physician’s medical record for the patient or the acute/post-acute care facility’s medical record for the patient or both, thereby creating a clinically consistent picture that the patient is eligible for Medicare home health services.

(ii)(A) The certifying physician signs and dates the HHA documentation demonstrating that the documentation from the HHA was considered when certifying patient eligibility for Medicare home health services.

(B) HHA documentation can include, but is not limited to, the patient’s plan of care required under § 409.43 of this chapter and the initial or comprehensive assessment of the patient required under § 484.55 of this chapter.

(2) The documentation must be provided upon request to review entities or CMS or both. If the documentation used as the basis for the certification of eligibility is not sufficient to demonstrate that the patient is or was eligible to receive services under the Medicare home health benefit, payment is not rendered for home health service.

CMS is asking for comments on the proposed changes by August 31, 2018.

Source: NAHC


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