Page 180 - Medicare Benefit Policy Manual

physician’s/NPP’s signature required on the change, (long term goal changes may be
accompanied by changes to procedures and modalities).

220.1.3 - Certification and Recertification of Need for Treatment and
Therapy Plans of Care
(Rev. 88, Issued: 05-07-08, Effective: 01-01-08, Implementation: 06-09-08)
Reference: 42CFR424.24(c)

See specific certification rules in Pub. 100-01, chapter 4, §20 for hospital services.

A. Method and Disposition of Certifications

Certification requires a dated signature on the plan of care or some other document that
indicates approval of the plan of care. It is not appropriate for a physician/NPP to certify
a plan of care if the patient was not under the care of some physician/NPP at the time of
the treatment or if the patient did not need the treatment. Since delayed certification is
allowed, the date the certification is signed is important only to determine if it is timely or
delayed. The certification must relate to treatment during the interval on the claim.
Unless there is reason to believe the plan was not signed appropriately, or it is not timely,
no further evidence that the patient was under the care of a physician/NPP and that the
patient needed the care is required.

The format of all certifications and recertifications and the method by which they are
obtained is determined by the individual facility and/or practitioner. Acceptable
documentation of certification may be, for example, a physician’s progress note, a
physician/NPP order, or a plan of care that is signed and dated by a physician/NPP, and
indicates the physician/NPP is aware that therapy service is or was in progress and the
physician/NPP makes no record of disagreement with the plan when there is evidence the
plan was sent (e.g., to the office) or is available in the record (e.g., of the institution that
employs the physician/NPP) for the physician/NPP to review. For example, if during the
course of treatment under a certified plan of care a physician sends an order for continued
treatment for 2 more weeks, contractors shall accept the order as certification of
continued treatment for 2 weeks under the same plan of care. If the new certification is
for less treatment than previously planned and certified, this new certification takes the
place of any previous certification. At the end of the 2 weeks of treatment (which might
extend more than 2 calendar weeks from the date the order/certification was signed)
another certification would be required if further treatment was documented as medically
necessary.

The certification should be retained in the clinical record and available if requested by the
contractor.

B. Initial Certification of Plan

The physician’s/NPP’s certification of the plan (with or without an order) satisfies all of
the certification requirements noted above in §220.1 for the duration of the plan of care,