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Physician Certification

How to Fund Your Palliative Care Program
Concurrent Session D Part 1
Reinbursement for Hospice Services
June 2002, Seattle, WA
Gretchen M. Brown, MSW & Susan Swinford, BSW, MSW
June 23rd & 24th 2002

Physician Certification

One of the most confusing requirements of the Medicare Hospice Benefit is the time frame the patient's physician and our Medical Director have to certify the patient as appropriate for hospice. The Corporate Compliance Committee of HOB is submitting this update to help clarify the issue for staff. If you have any questions, please don't hesitate to talk to your supervisor about certifications. Certifications are the first step in complying with the Medicare Conditions of Participation!

  • The purpose of the certification is for the physician(s) to certify the beneficiary has a medical prognosis that his/her life expectancy is six months or less if, the terminal illness runs its normal course.
  • A physician certification is required at the beginning of each benefit period.

Initial Physician Certification

  • The first 90-day benefit period must:
    • Be obtained and signed no earlier than two weeks before the admission, and
    • No later than two days after hospice care is initiated
    • The initial physician certification must be completed, signed and dated by:
      • Medical Director of Hospice, and
      • The patient's attending physician
  • If the signed certification is not received within two days:
    • A verbal order may be obtained from the physicians
  • The Balanced Budget Act of 1997 made the following change to the certification process:
    • Written certification must be obtained before the claim is billed to Medicare.

Physician Re-Certification

  • Physician re-certification must be obtained no later than two calendar days after the first day of each benefit period
  • The re-certification must state beneficiary has a life expectancy of six months or less
  • The re-certification must be signed and dated by a physician:
    • Medical Director, OR
    • Attending physician
  • The attending physician does not need to re-certify the patient but may further support the patient's appropriateness for hospice by also re-certifying.
  • Re-certifications may not be obtained more than 5 days before the new certification period
  • All certifications should be kept on file in the patient's record.

Additional Resources

Reimbursement for Hospice Services 1/2
How to Fund Your Palliative Care Program
Concurrent Session D Part 1
June 2002, Seattle, WA
Gretchen M. Brown, Connie A. Raffa, JD, LLM & Susan Swinford, BSW, MSW
PowerPoint Presentation

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