Please note that this article contains information that is only relevant to American clinics.
A recent article from Gawenda Seminars and Consulting made note of the fact that many clinics are having their claims denied because the physician “the physician did not certify (sign and date) the plan of care in a timely manner.” As such, we’ll be taking this opportunity to discuss the size and scope of the Medicare audit and define delayed certification.
As some of you may be aware, Medicare has hired an agency called Strategic Health Solutions to help them audit facilities who provided individual patients with Medicare Part B Therapy Services exceeding $3,700.
The audit further narrows its focus by targeting facilities with patients who exceeded this limit in the 2015 calendar year, and have more patients who exceed this threshold in comparison to their peers. And any of those who have been selected for the audit have reported multiple instances of claims be denied because of their failure to certify their patients’ plan of care in a timely manner.
So, how does one avoid having their claims denied because of this? The answer is delayed certification and there are two ways it may be performed.
The article from Gawenda Seminars and Consulting stated that the first method of delayed certification “occurs when the initial plan of care is signed and dated by the non-physician practitioner (NPP) more than 30 days from the initial evaluation and/or treatment date.” More specifically, they may be completed 31-60 days after the initial evaluation. Similarly, a recertification will also be eligible for delayed certification if the physician or NPP sings and dates the document up to 30 days after the re-evaluation.
The second method of delayed certification occurs when the initial certification is signed and dated more than 60 days after the evaluation, or when the recertification is signed and dated more than 30 days after the re-evaluation. In these cases, you must also offer a written explanation and justification for the delayed certification.