Managed Care

Physician Signature Date Will be Mandated and Enforced

Homecare Insider, December 6, 2010

Under the 2011 Home Health PPS Final Rule, the Centers for Medicare and Medicaid Services (CMS) has announced that for all claims submitted on or after January 1, 2011 Medicare home health certifications and recertifications must not only be signed by the physician, but must also be dated by that physician.

According to the National Association for Home Care and Hospice (NAHC), CMS advised its contractors last week of their interpretation of the final rule and referenced current policy manual citations as the basis for its authority. The policy referenced by CMS is located in the Medicare General Information, Eligibility and Entitlement Manual (Pub. 100-01), Chapter 4, Section 30.1, and it states: “The attending physician signs and dates the POC/certification prior to the claim being submitted for payment.” This requirement will be put into regulation at 42CFR 424.22 (D) 2 as follows: “The certification of need for home health services must be obtained at the time the plan of care is established or as soon thereafter as possible and must be signed and dated by the physician who establishes the plan.” For recertifications, “recertification is required at least every 60 days, preferably at the time the plan is reviewed, and must be signed and dated by the physician who reviews the plan of care.” 

This requirement will no longer allow providers to date or date stamp certifications, recertifications, supplemental orders, or lab requisitions. Providers have long been using date stamps without an issue from CMS, but now will not be permitted. CMS stated in a response to NAHC that “program integrity limits the use of date stamps”.

NAHC has promised to continue to lobby CMS to allow providers to affix the date of receipt as proof of physician signature timing. However, during the CMS Open Door Forum on December 1, CMS maintained its position.

Many in the homecare community are concerned about receiving orders without dated signatures and the action they should take if this happens. It is important that providers send or fax documents back if the physician fails to include the date. Agencies should take a proactive approach with physicians so that no extra steps are needed. Any extra steps can further delay the receipt of orders.

The January edition of Homecare DIRECTION will further discuss this new requirement and provide more guidance for compliance.  To learn more about this monthly newsletter for clinical managers, click here.

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