Home Health Certifying Provider Change

Home health certifying physician or nonphysician practitioner (NPP) changes can occur anytime for a variety of reasons. Some examples may include practitioner retirement, vacation, or patient choice.

Regardless of the circumstance, if the recertifying physician or NPP is different from the certifying physician or NPP, home health agencies (HHAs) are required to document in the medical record indicating they have ensured a different physician or NPP has been authorized to care for (including recertifying and signing the plan of care) the original certifying physician’s or NPP’s patients in their absence. 

For example, if "Dr. A" signed the initial certification and "Dr. B" signed the recertification, the HHA should ensure and document that this has been authorized by “Dr. A.” However, there does not need to be written or signed documentation from the physician or NPP.

There is no designated format or form that must be used to show the change in provider. Documentation can be anything from the HHA that shows the HHA has confirmed the change(s) in certifying physician or NPP. HHAs are encouraged to include any documentation that support attempts to contact the original practitioner when changes occur. 

Reviewers 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.

Resources

• Centers for Medicare & Medicaid Services, HHS § 484.60 — Condition of participation: Care planning, coordination of services, and quality of care (PDF)
• Code of Federal Regulations §424.22 Requirements for home health services
• Medicare Benefit Policy Manual Chapter 7 — Home Health Services
• Medicare Program Integrity Manual Chapter 6 — Medicare Contractor Medical Review Guidelines for Specific Services