Home Health & Hospice

What aspects of certification documentation does Change Request 9189, which took effect last week, instruct Medicare contractors to consider when determining whether to award coverage for home health services?

Homecare Insider, August 17, 2015

The change request instructs Medicare contractors to review a patient’s entire medical record to determine whether the individual meets the eligibility criteria for home health services. In other words, the physician-kept record must include information that supports all the required elements for certification, including:
  • The need for skilled service
  • Reason for homebound status
  • The occurrence of a valid face-to-face (F2F) encounter
Additionally, CMS directs contractors to consider all documentation from the home health agency that appears in the patient’s record when making its coverage determination—as long as the materials have been signed off by a physician prior to or at the time of the certification.