Physician Recertification

Home health certification periods run 60 days, and each contains two 30-day payment periods under the Patient-Driven Groupings Model. When the patient needs care beyond the current 60-day period, the practitioner must recertify eligibility, and recertification recurs at least every 60 days for as long as the patient remains on service. The recertification is tied to the practitioner's review of the plan of care for the upcoming period, so in practice the signed, updated plan of care and the recertification statement usually travel together. There is no limit on the number of recertification periods as long as eligibility continues to be met and documented.

A compliant recertification attests to continued homebound status and continued need for intermittent skilled nursing, physical therapy, or speech-language pathology (or continuing occupational therapy once eligibility is established), under a plan of care the practitioner has reviewed. It must be signed and dated by the physician or allowed practitioner, and it must include an estimate of how much longer skilled services will be required. That estimate is a frequent review finding when omitted. No new face-to-face encounter is needed at recertification; the encounter requirement belongs to the initial certification and to any new start of care after a discharge.

Two separate obligations converge at the end of each 60-day period and are easy to conflate. The recertification OASIS assessment is a clinical requirement: a comprehensive assessment completed during the last five days of the current period, days 56 through 60, which also drives case-mix for the next payment periods. The physician recertification is a coverage requirement: the practitioner's signed attestation of continued eligibility. An on-time OASIS with a missing or unsigned recertification still leaves the next period unbillable, and a signed recertification cannot substitute for a late assessment. Track them as distinct items with distinct owners, clinical and administrative.

Recertification failures are mostly workflow failures:

• Signatures chased after the period begins, holding final claims and inflating days sales outstanding
• The estimate of continued need omitted from the recertification statement
• Documentation that no longer supports homebound status or skilled need after multiple periods on service
• Plan of care updates that do not match actual visit frequencies or current medications
• Recertification OASIS completed outside the day 56 to 60 window

High-performing agencies start the recertification package around day 50, route it electronically for signature, and have QA compare the clinical record against eligibility criteria before the new period is billed.