Hospice Certification and Recertification Attestation Requirements

Categories: Policy.

The National Hospice and Palliative Care Organization is offering guidance regarding required physician narratives for hospice certification and recertification.

In discussions with NHPCO, the MACs cited examples where, upon medical review, it was determined that another staff member wrote the narrative and the physician signed it.  NHPCO and the MACs have agreed to release the following guidance to hospice providers regarding the language in the attestation statement. 

Message from the Medicare Administrative Contractors

In order for a patient to be eligible for the Medicare hospice benefit, the patient must be certified as being terminally ill.  An individual is considered to be terminally ill if the medical prognosis is that the individual’s life expectancy is six months or less if the illness runs its normal course.  The certification/rectification is a critical piece of documentation necessary to ensure Medicare payment for the hospice services you provide. 

One of the requirements of the certification/recertification form is the physician narrative and attestation statement.   The CMS Benefit Policy Manual, Pub. 100-02, Chapter 9, section 20.1 states the narrative shall include a statement, located above the physician signature and date, that attests to the fact that by signing the form, the physician confirms that he/she composed the narrative based on his/her review of the patient’s medical record or his/her examination of the patient.

During each MAC’s review of hospice documentation by medical review staff, we have identified several attestation statements that do not clearly indicate that the physician was the one that composed the narrative.  Statements such as “I confirm that this narrative is based on my review of the patient’s medical record and/or examination of the patient” do not specifically indicate that the physician actually composed the narrative.  MACs have had instances where a physician has signed certifications with this type of attestation statement, and upon further research, it was determined that the non-physician practitioner actually composed the certification narrative for the physician to sign, which is not compliant with the regulations.

Each MAC strongly recommends that providers review their certification/recertification attestation statements to ensure they are in compliance with the requirement found in section 20.1, and that the statements clearly indicating who composed the certification narrative.  Although the guidelines do not mandate specific verbiage, attestation statements that do not clearly indicate the certifying physician composed the narrative may result in a denial for an invalid certification/recertification.  Claims denied due to missing or invalid certifications of terminal illness are subject to standard appeal rights.  Please refer to the Appeals section on our website for additional information.

Action Item for Hospice:  Providers should check attestation statements for the narrative, to ensure that the language in bold above is included.  Make changes immediately if that language does not meet this language.  If your hospice’s Electronic Medical Record (EMR) does not include the composed language in the attestation, notify your software vendor immediately to make the correction. 

Making changes now will avoid additional claims being denied in the future for this reason.

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