Harmony Healthcare Blog

PDPM - Where are We Now Q&A: Part 4

Posted by The Harmony Team on Tue, Feb 18, 2020


Edited by Kris Mastrangelo

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency


STOCK people listening and laughing-1Question 4 of 9: For the certification form on admission, how many days does the MD/NP have to sign? If a person admits late on a Friday and the practitioner is not in the facility until Tuesday or after, would that suffice?

According to the Medicare Benefit Policy Manual Chapter 8 – Coverage of Extended Care (SNF) Services under Hospital Insurance. 40- Physician Certification and Re-Certification for Extended Care Services,

“Certifications must be obtained at the time of admission, or as soon
thereafter as is reasonable and practicable. The routine admission
order established by a physician is not a certification
of the necessity
for post-hospital extended care services for purposes of the program.
There must be a separate signed statement indicating that the patient
will require on a daily basis SNF covered care.”

Based on the above question, signing the certification on day 5 should suffice. It is also important to note that the Physician Certification forms can be signed and faxed by the physician in cases when the physician can’t visit the facility in person. 

CMS does not require a specific certification or recertification process format but does have a list of requirements to be met for the resident's stay to be deemed valid.  (Rev. 101, Issued 9/16/16 effective 10/18/16, Implementation 10/18/16) 

The Medicare General Information, Eligibility and Entitlement
Chapter 4 Physician Certification and Re-Certification of Service

  • “The initial certification must be obtained at the time of admission or as soon thereafter as reasonable and practicable.”
  • Faxed signatures are acceptable.
  • CMS does not provide a set time frame but does accept and honor delayed certifications. Where there has been an isolated oversight or lapse in getting completed. (must include the reason for the delay with any medical or evidence the SNF considers relevant for purpose of explaining the delay)
  • The certification must clearly indicate that post-hospital extended care is required by clearly indicating:
    • Skilled nursing or rehabilitation services are required on a daily basis.
    • Services can only be provided in a SNF or swing bed.
    • Services are for a condition that was treated or arose during the hospital stay.
  • The certification can be signed by the attending physician or a physician on staff of the SNF who has knowledge of the case or by a physician extender who does not have a direct or indirect employment relationship with the facility but who is working in collaboration with the Physician.

Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have.  You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 


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Tags: PDPM, Certification Form, Admission

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