CMS Pub. 100-08, ch. 6, § 6.2.2.1

Recertification is required at least every 60 days when there is a need for continuous

home health care after an initial 60-day episode. Recertification should occur at the time

the plan of care is reviewed, and must be signed and dated by the physician who reviews

the plan of care. Recertification is required at least every 60 days unless there is a—

(i) Beneficiary elected transfer; or

(ii) Discharge with goals met and/or no expectation of a return to home health

care.

Medicare does not limit the number of continuous episode recertifications for

beneficiaries who continue to be eligible for the home health benefit. The physician

certification may cover a period less than but not greater than 60 days. Because the

updated home health plan of care must include the frequency and duration of visits to be

made, the physician does not have to estimate how much longer skilled services will be

needed for the recertification.

The recertification statement must indicate the continuing need for services. Need for

occupational therapy may be the basis for continuing services that were initiated because

the individual needed skilled nursing care or physical therapy or speech therapy. In this

case reviewers will look for documentation substantiating the need for continued

occupational therapy when the needed skilled nursing care or physical therapy or speech

therapy that were initially needed, are no longer needed.

If a patient’s underlying condition or complication requires a registered nurse to ensure

that essential non-skilled care is achieving its purpose, and necessitates a registered nurse

be involved in the development, management, and evaluation of a patient’s care plan, the

reviewer will look for the physician’s brief narrative describing the clinical justification

of this need. If the narrative is part of the recertification form, then the narrative must be

located immediately prior to the physician’s signature. If the narrative exists as an

addendum to the recertification form, in addition to the physician’s signature on the

recertification form, the physician must sign immediately following the narrative in the

addendum.

As mentioned earlier in this section, the reviewer will confirm that all elements of the

certification are included in the documentation sent for the recertification claim review.

If the submitted certification documentation (submitted with the recertification

documentation) does not support home health eligibility, the claim associated with the

recertification period will not be paid.