Re: cert's/700 forms

[Caralyn Davis]

Cites from two places. I've bolded parts of interest. I think this is the "in writing" you seek-Caralyn   1. From Chapter 4, General Information, Entitlement and Eligibility Manual, http://www.cms.gov/manuals/101_general/ge101c04.asp#40   40 - Certification and Recertification by Physicians for Extended Care Services - (Rev. 1, 09-11-02)     Payment for covered posthospital extended care services may be made only if a physician makes the required certification and, where services are furnished over a period of time, the required recertification regarding the services furnished.     The skilled nursing facility is responsible for obtaining the required physician certification and recertification statements and for retaining them in file for verifications, if needed, by the intermediary. The skilled nursing facility determines the method by which the physician certification and recertification statements are to be obtained. There is no requirement that a specific procedure or specific forms be used, as long as the approach adopted by the facility permits a verification to be made that the certification and recertification requirements are in fact met. Certification and recertification statements may be entered on or included in forms, NOTEs, or other records a physician normally signs in caring for a patient, or a separate form may be used. Except as otherwise specified, each certification and recertification statement is to be separately signed by a physician.     If the facility's failure to obtain a certification or recertification is not due to a question as to the necessity for the services, but rather to the physician's refusal to certify based on other grounds (e.g., he objects in principle to the concept of certification and recertification), the facility may not bill the program or the beneficiary for covered items or services. The provider agreement which the facility files with the Secretary precludes it from charging the patient for covered items and services.     If a physician refuses to certify because, in his/her opinion, the patient does not require skilled care on a continuing basis for a condition for which he/she was receiving inpatient hospital services, the services are not covered and the facility can bill the patient directly. The reason for the physician's refusal to make the certification must be documented in the facility records. For such documentation to be adequate, there must be some statement in the facility's records, signed by a physician or a responsible facility official, indicating that the patient's physician feels that the patient does not require skilled care on a continuing basis for any of the conditions for which he/she was hospitalized.   40.1 - Who May Sign the Certification or Recertification for Extended Care Services - (Rev. 1, 09-11-02)     A certification or recertification statement must be signed by the attending physician or a physician on the staff of the skilled nursing facility who has knowledge of the case or by a nurse practitioner or clinical nurse specialist who does not have a direct or indirect employment relationship with the facility, but who is working in collaboration with the physician.     Ordinarily, for purposes of certification and recertification, a "physician" must meet the definition contained in Chapter 5, �70 of this manual.   40.2 - Certification for Extended Care Services - (Rev. 1, 09-11-02)     The certification must clearly indicate that posthospital extended care services were required to be given on an inpatient basis because of the individual's need for skilled care on a continuing basis for any of the conditions for which he/she was receiving inpatient hospital services, including services of an emergency hospital (see Chapter 5, �20.2 prior to transfer to the SNF. Certifications must be obtained at the time of admission, or as soon thereafter as is reasonable and practicable. The routine admission procedure followed by a physician would not be sufficient certification of the necessity for posthospital extended care services for purposes of the program. If ambulance service is furnished by a skilled nursing facility, an additional certification is required. It may be furnished by any physician who has sufficient knowledge of the patient's case, including the physician who requested the ambulance or the physician who examined the patient upon his arrival at the facility. The physician must certify that the ambulance service was medically required. 40.3 - Recertifications for Extended Care Services - (Rev. 1, 09-11-02)     The recertification statement must contain an adequate written record of the reasons for the continued need for extended care services, the estimated period of time required for the patient to remain in the facility, and any plans, where appropriate, for home care. The recertification statement made by the physician does not have to include this entire statement if, for example, all of the required information is in fact included in progress NOTEs. In such a case, the physician's statement could indicate that the individual's medical record contains the required information and that continued posthospital extended care services are medically necessary. A statement reciting only that continued extended care services are medically necessary is not, in and of itself, sufficient. If the circumstances require it, the first recertification and any subsequent recertifications must state that the continued need for extended care services is for a condition requiring such services which arose after the transfer from the hospital and while the patient was still in the facility for treatment of the condition(s) for which he/she had received inpatient hospital services. 40.4 - Timing of Recertifications for Extended Care Services - (Rev. 1, 09-11-02)     The first recertification must be made no later than the l4th day of inpatient extended care services. A skilled nursing facility can, at its option, provide for the first recertification to be made earlier, or it can vary the timing of the first recertification within the l4-day period by diagnostic or clinical categories. Subsequent recertifications must be made at intervals not exceeding 30 days. Such recertifications may be made at shorter intervals as established by the utilization review committee and the skilled nursing facility. At the option of the skilled nursing facility, review of a stay of extended duration, pursuant to the facility's utilization review plan (if a UR review plan is in place), may take the place of the second and any subsequent physician recertifications. The skilled nursing facility should have available in its files a written description of the procedure it adopts with respect to the timing of recertifications. The procedure should specify the intervals at which recertifications are required, and whether review of long-stay cases by the utilization review committee serves as an alternative to recertification by a physician in the case of the second or subsequent recertifications. 40.5 - Delayed Certifications and Recertifications for Extended Care Services - (Rev. 1, 09-11-02)     Skilled nursing facilities are expected to obtain timely certification and recertification statements. However, delayed certifications and recertifications will be honored where, for example, there has been an isolated oversight or lapse.       In addition to complying with the content requirements, delayed certifications and recertifications must include an explanation for the delay and any medical or other evidence which the skilled nursing facility considers relevant for purposes of explaining the delay. The facility will determine the format of delayed certification and recertification statements, and the method by which they are obtained. A delayed certification and recertification may appear in one statement; separate signed statements for each certification and recertification would not be required as they would if timely certification and recertification had been made. 40.6 - Disposition of Certification and Recertifications for Extended Care Services - (Rev. 1, 09-11-02)     Skilled nursing facilities do not have to transmit certification and recertification statements to the intermediary; instead, the facility must itself certify, in the admission and billing form, that the required physician certification and recertification statements have been obtained and are on file.   50 - Physician's Certification and Recertification for Outpatient Physical Therapy - (Rev. 1, 09-11-02) 50.1 - Content of Physician's Certification - (Rev. 1, 09-11-02)     No payment is made for outpatient physical therapy, occupational therapy, or speech pathology services unless a physician certifies that:     * The outpatient physical therapy, occupational therapy, or speech pathology services are or were furnished while the patient was under the care of a physician;     * A plan for furnishing such services is or was established by the physician, physical therapist, occupational therapist, or speech pathologist and periodically reviewed by the physician; and     * Services are or were required by the patient.     Since the certification is closely associated with the plan of treatment, the same physician who establishes or reviews the plan must certify to the necessity for the services. Providers obtain the certification at the time the plan of treatment is established or as soon thereafter as possible. Physician means a doctor of medicine, osteopathy (including an osteopathic practitioner), or podiatric medicine legally authorized to practice by the State in which he/she performs these services. In addition, physician certifications or recertifications by doctors of podiatric medicine must be consistent with the scope of the professional services provided by a doctor of podiatric medicine as authorized by applicable State law.   50.2 - Recertificaton - (Rev. 1, 09-11-02)     When outpatient physical therapy, occupational therapy, or speech pathology services are continued under the same plan of treatment, the physician must recertify at intervals of at least once every 30 days that there is a continuing need for such services and estimate how long services are needed. Providers obtain the recertification at the time the plan of treatment is reviewed since the same interval (at least once every 30 days) is required for the review of the plan. Recertifications are signed by the physician who reviews the plan of treatment. The form and manner of obtaining timely recertification is up to the provider.   2. From July program memo from CMS,  http://www.cms.hhs.gov/manuals/pm_trans/R43PI.pdf NEW/REVISED MATERIAL - EFFECTIVE DATE: July 1, 2003 IMPLEMENTATION DATE: July 1, 2003   Medicare contractors only: these instructions should be implemented within your current operating budget.     The documentation that supports the Plan of Care must be in the medical record. Therefore, we will no longer mandate the use of the Plan of Treatment for Outpatient Rehabilitation (HCFA Form 700) or the Updated Plan of Progress for Outpatient Rehabilitation (HCFA Form 701) in Exhibit 24. We are deleting the forms, all Program Integrity Manual Chapter 9 references to the forms, and table of contents references to the forms. Instead, providers may use any written format, including a form resembling the HCFA Forms 700/701, to convey the required information.   ----- Original Message ----- From: MDS Lady To: MDS Group Sent: Thursday, December 11, 2003 5:45 PM Subject: cert's/700 forms I am trying to locate "in writing" the requirement that we cannot bill the FI until the certs & recerts, 700 & 701s are signed. Can someone help me on this? Thx in advance!   Do you Yahoo!? Free Pop-Up Blocker - Get it now