Initial Certifications & recertification of terminal illness should be performed by the medical director of the hospice or the physician member of the hospice’s IDG.
Recertification may be completed no more than 15 calendar days prior to the start of the subsequent benefit period.
The RN case manager directly involved in the patient's care can perform a nurse recertification as an "administrative component" in order to assist the Medical Director in making the final determination of a life expectancy of 6 months of less. It is recommended that they complete the nurse recertification within the specific time frame in order to have enough time to gather enough information so that the medical director can make the final determination of a life expectancy of 6 months of less.
*The nurse recertification documentation included within the Hospice Tools EMR is not a requirement per Medicare Benefit Policy.
A complete written certification/recertification must include:
1. The statement that the individual’s medical prognosis is that their life expectancy is 6 months or less if the terminal illness runs its normal course
2. Specific clinical findings and other documentation supporting a life expectancy of 6 months or less
3. The signature(s) of the physician(s), the date signed, and the benefit period dates that the certification or recertification covers (for more on signature requirements, see Pub. 100-08, Medicare Program Integrity Manual, chapter 3, section 3.3.2.4)
4. As of October 1, 2009, the physician’s brief narrative explanation of the clinical
findings that supports a life expectancy of 6 months or less as part of the certification and recertification forms, or as an addendum to the certification and recertification forms
Resources:
eCFR :: 42 CFR Part 418 -- Hospice Care