Essential Guidance for MDS Clinicians & Medical Records Teams
The Medicare Part A Physician Certification is a critical form that certifies a resident’s need for skilled care under Medicare. For skilled nursing facilities (SNFs), ensuring this form is completed accurately is essential for compliance and reimbursement. As we prepared to update our knowledge of the PDPM model in collaboration with a compliant & through completion of the mandatory physician certification process tools.
Beyond routine completion, this form should reflect key components of the Patient-Driven Payment Model (PDPM) to capture the resident’s skilled needs fully. Here’s an in-depth look at the PDPM elements that should be documented and guidance on how often the form needs a physician’s signature, as well as who is typically responsible for its completion and tracking.
Who Is Responsible for Completing and Tracking the Certification?
In SNFs, responsibility for the Medicare Part A Physician Certification is often assigned to the following roles:
- MDS Coordinators: As part of their role in assessing resident needs and ensuring accurate documentation, MDS Coordinators play a vital role in tracking the skilled services included in the certification.
- Medical Records Personnel: These staff members ensure compliance with documentation guidelines, including the completion and timely renewal of the physician certification.
- Business Office Managers: Often involved in the billing and compliance aspects, Business Office Managers may also oversee the completion and tracking of certifications.
Stay Compliant
Team members should work together to ensure the form’s accuracy and completeness, coordinating with the physician to ensure timely certification
How often does the form need Physican Signatures?
Medicare requires that the Part A Physician Certification be signed:
- At the start of the resident’s skilled stay to document initial certification.
- Within the first 14 days of the stay, providing a continued statement of the resident’s skilled needs.
- Every 30 days thereafter for ongoing stays requiring skilled care.
Regular tracking of these intervals is essential to meet Medicare’s certification requirements, especially when residents remain in skilled care for extended periods.
Key PDPM Components to Document in the Physican Certification Form
To align the Medicare Part A Physician Certification with PDPM requirements, it’s crucial to document the skilled needs accurately. This includes not only therapy and nursing services but also Non-Therapy Ancillary (NTA) needs, which impact reimbursement under PDPM.
Therapy Services
If the resident receives physical, occupational, or speech therapy, document these services clearly. Include specific goals and skilled interventions that justify the therapy needs, such as mobility improvement, speech recovery, or daily living skills. Therapy is a key PDPM component that substantiates the resident’s skilled status and impacts PDPM reimbursement levels.
Skilled Nursing Services
Skilled nursing services must be detailed in the certification, especially complex medical needs that require skilled oversight. Documenting specific nursing interventions like wound care, intravenous (IV) therapy, respiratory treatments, and specialized medication management highlights the resident’s skilled needs and qualifies them under PDPM guidelines.
Non-Therapy Ancillaries (NTAs)
NTAs represent a wide range of non-therapy clinical conditions and services that can impact the reimbursement rate under PDPM. Examples of NTAs that should be documented include:
- Items under the NTA Guidelines captured for reimbursement such as morbidly obesity, malnutrition, immune disorders, DM and much more.
- Be sure to list as many NTA services as possible on the Physican Certification form
By documenting NTAs, facilities capture the additional costs associated with these intensive services. Including NTA details on the Physician Certification helps align the certification with the resident’s care needs and ensures accurate PDPM reimbursement.
Importance of Accurate Documentation and Tracking
Failing to include all relevant PDPM components, especially NTAs, can lead to underreporting of skilled services and lower reimbursement rates. Consistent and precise documentation also protects the facility in case of an audit, as it verifies that all billed services reflect the resident’s actual care needs.
Tips for Efficient Tracking and Timely Certification Renewal
- Set Reminders: Use tracking software or calendar reminders to ensure the certification is signed within the required intervals.
- Weekly Review Meetings: Hold brief team meetings to review upcoming certifications that need renewal and confirm all PDPM components are included.
- Collaborate with Physicians: Encourage open communication with physicians to streamline the signature process, reducing delays in certification.