SNF Certification and Recertification for Medical Review - JE Part A
SNF Certification and Recertification for Medical Review
The Medicare program conditions of payment require a physician certification and (when specified) recertification for SNF services. Analysis of claim denials from CERT, RA and MAC contractors has identified a trending related to the failure to comply with the certification or re-certification requirements. Providers are reminded to comply, maintain, and submit this documentation upon request to review contractors to support this requirement for condition of payment. SNF certification and recertification must be signed and timely in accordance with CMS regulations.
To meet requirements the certification or recertification statement must clearly indicate posthospital extended care services were required because of the individual's need for skilled care on a continuing basis for which he/she was receiving inpatient hospital services. The statement must be signed:
- By an attending physician or a physician on the staff of the skilled nursing facility who has knowledge of the case, or
- A nurse practitioner (NP), clinical nurse specialist (CNS) or a physician assistant (PA) who does not have a direct or indirect employment relationship with the facility, but who is working in collaboration with the physician.
Timing of Certification/Recertifications
- The initial Certification is due at the time of admission, or as soon thereafter as is reasonable and practicable.
- The first recertification must be made no later than the 14th day of inpatient extended care services.
- Subsequent recertifications are required at intervals not to exceed 30 days.
Delayed certifications and recertifications are allowed for an isolated oversight or lapse. The delayed certification or recertification must include an explanation of the delay along with any other information the SNF considers relevant to explain the delay.
- CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 6, Section 6.3
- CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 8, Section 40
- CMS IOM, Publication 100-01, Medicare General Information, Eligibility, and Entitlement Manual, Chapter 4, Section 40