Page 261 - CHHA Binder 2.3.20

4/11/2019

Recertification

Important Considerations:
 Clinical Need:

You will need:
• to determine and justify recertification.
• consider if the patient a candidate for referral to MLTC program?

 Fiscals:
• Are services requested in Recert billable to the patient’s insurance?
(Medicare will not pay for non-skilled care!)
• Is payor change needed? (Remember your ABN).

 MD order:
• Does the MD agree with plan to recert and the recert POC?

 Services

• Is the patient agreeable to the recert?

Planning for a Recert

Planning for a Recert
 Recert is placed on the patient schedule (RN02) at SOC if it is clear that
patient will need services beyond 60 Days or during any time during the
epsiode.

 The actual Recert must be done during the last 5 days of a certification
period. This is days 56-60. A subsequent RN visit must be scheduled.

 Unless there are compelling circumstances, a Recert should never be
scheduled on a weekend!
 In the event that a ROC occurs between day 56- 60 this will take the place
of a Recert
 If there is no Skill select RN 03 otherwise select RN 02(discuss with CFM)
HCHB Service Codes
Recert with Skill RN 02
Recert without Skill RN 03
ROC/Recert (ROC within the 5 day EOE window) RN 05

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