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Physician Documentation Requirements for Certification of Home Health Care

Medicare has changed the physician documentation requirements for certification of home health care for dates of service effective 1/1/2015. While clinicians still need to certify benefit eligibility and a face-to-face encounter is still required, the need for extra documentation (e.g., the “narrative”) has been scaled back or eliminated. These remaining requirements may be billed in the following manner: a face-to-face encounter with a physician or allowed nonphysician practitioner is billed with an E&M code and the certification is billed with G0180 (G0179 for recertification). The HHA will provide medical records from the office or hospital setting describing the patient’s condition and supporting his/her eligibility for home care prior to your completion of the certification document. The agency may need progress notes from you or hospital records of the face-to-face visit if it was done in the hospital setting in order to substantiate the reason home health care is needed.

In review, to qualify for the Medicare home health benefit, beneficiaries must have Medicare Part A and/or Part B and meet all of the following requirements:

  • Be confined to the home;
  • Need skilled services;
  • Be under the care of a physician;
  • Receive services under a plan of care established and periodically reviewed by a physician; and
  • Have a face-to-face encounter with a physician or allowed with a physician or allowed NPP (reviewed and counter-signed by the physician).

Your home health/hospice Medicare contractor’s website may be accessed to obtain information regarding eligibility and documentation requirements.

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Physician Documentation Requirements for Certification of Home Health Care
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