Chart audits revealed an opportunity to obtain timely physician certifications and re-certifications. The skilled qualifiers must also be identified for the re-certifications versus signed blank. On medical review, the claim may be denied if this technical criteria is not met. Medicare beneficiaries receiving daily skilled nursing services are of priority as the physician certifies the therapy plan of care for patients on skilled rehabilitation services. Certification for all beneficiaries is essential.
Examples of skilled qualifiers may include:
- Daily skilled nursing for observation and assessment of: (list conditions)
- Overall management of care plan for: (list conditions)
- Daily skilled PT and OT for: (identify conditions)
- Daily skilled nursing or rehabilitation services for teaching and training in: (identify)
Harmony (HHI) recommends using skilled Medicare terminology when identifying skilled qualifiers on the certification and re-certification form. Technically, a form is not required if the physician identifies in progress notes or orders why the patient requires ongoing skilled care within the established time frames. As this is difficult to obtain and track, the certification/re-certification form best satisfies this Medicare requirement.
Example of Justification for Skilled Care on MD Certification: Daily skilled observation and assessment by nursing to include post-surgical care regarding incisional healing, observation of signs and symptoms of infection and monitoring of the delivery of anticoagulant therapy. Skilled PT to address transfer training and gait training. Skilled OT to address ADL training and toileting.
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