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Is there a specific required form for Skilled Nursing Facility (SNF) certifications and recertifications?

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Is there a specific required form for Skilled Nursing Facility (SNF) certifications and recertifications?

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According to the Skilled Nursing Facility Manual (CMS-Pub. 12), section 220 (Physician Certification and Recertification), a certification or recertification statement for SNF care is a statement made by a physician indicating the patient’s medical condition requires post hospital extended care skilled services. The certification/recertification statement should be obtained from the physician and retained within the patient’s medical record. If a request for records for medical review is received from your intermediary, the certification/recertification should be included with the medical record documentation submitted. There is no specific procedure or form that must be utilized as long as the approach selected permits verification that the certification/recertification requirement has been met. This statement may be entered or included in existing forms, notes, or other records a physician normally signs in caring for a patient, or on a separate form. Except as otherwise specified (s

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