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July 22, 2015

Medical Review Additional Development Request for Home Health Services

The Centers for Medicare & Medicaid Services (CMS) issued Change Request 9189External PDF, which updates the home health medical review policy regarding physician certification and recertification of patient eligibility, as published in the 2015 Home Health Prospective Payment System Final Rule.

As a result, effective for dates of service on or after August 11, 2015, when a claim is selected for medical review, providers will be required to submit all certification documentation as well as recertification documentation. CGS will review the initial certification and face-to-face documentation with every claim including a recertification. In addition, providers are reminded to carefully review the additional development request (ADR) message to ensure all the requested documentation is submitted. To learn more about the ADR process, refer to the Medical Review Additional Development Request (ADR) Process Web page on the CGS website.

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