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Pediatric Recertification

Can anyone help me. I have worked for my pediatric home care agency for 7 year now. We had a medicare auditor do an onsite visit for our medicare licensure. She is telling my director that even long term pedicatric patients need to be recerted every 60 days. Is this true..? Most of our patients are medicaid, not medicare. Do the same standards apply for recerts and OASIS patients. :trout: Does anyone have literature to support this. I have reviewed all of the CMS guidelines and I can't find anything for pedicatrics, it's all oasis. Thanks for your time.

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Pediatric patients do not need to have an OASIS done on them unless they are over 18. As a Medicare Certified Agency, you need to follow all of Medicare rules with all payer sources, that means recertifying pediatric patients every 60 days. You are not held accountable for the 5 day window, but there cannot be a longer period than 60 days between recerts. Check your Medicare Condition of Participation rules. Clarrification of that rule came out a couple of years ago.

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Can anyone cite the CMS's requirment on pedicatric certification and also clarifying missed cert periods....

go to cms.gov and choose home health under providers - go to the conditions of participation, interpretive guidelines for state surveyors - page 10 of 96 in essence states that if you are a medicare certified agency - which most states require to provide medicaid services - you must follow the Medicare conditions of participation unless otherwise directed. I copy and pasted the link - it is a PDF file. Hope this helps.

http://www.cms.hhs.gov/GuidanceforLawsAndRegulations/downloads/som107ap_b_hha.pdf

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