Skilled Nursing Facility Certifications & Recertifications

The Centers for Medicare and Medicaid Services (CMS) has issued a special publication that alerts providers that a major reason for claims being denied is failure to obtain certification and recertification statements from physicians or NPPs. The routine admission order established by a physician is not a certification of the necessity for post hospital extended care services for purposes of the program. Your therapy and billing staff needs to be aware of the requirements outlined below of what is an acceptable certification statement, what is an acceptable recertification statement, and how and when to document the certification and recertification statements.