Certification content
Signed, individualized physician narrative (not checkbox or templated language) that supports a terminal prognosis of six months or less — present, or the file does not release.
The most rigorous eligibility file a hospice can submit.
RecertShield assembles a documentation-complete eligibility file and audit-response package — every regulatory element, every required narrative check, the physician narrative gap analysis, the IDG note corroboration, and the benefit-period calendar — checked against 42 CFR Part 418 and the applicable Local Coverage Determination before a credentialed hospice compliance nurse reviewer certifies it.
Every subsection of 42 CFR Part 418Five statutory certification elements, gate-checkedPhysician narrative · IDG notes · F2F encounter · NOE · election addendumCredentialed nurse reviewer release on every file5-business-day SLA
Why files fail
A single missing element can trigger a denial or audit flag.
A hospice agency's eligibility recertification is only as strong as the documentation behind it. Miss a signed, individualized physician narrative, fail to corroborate the IDG notes with a six-month prognosis, skip the face-to-face encounter documentation, mis-time the Notice of Election, or omit the election-statement addendum — and the file can be denied, flagged for prepayment review, or exposed to fraud-model scrutiny.
Most agencies run this by hand, from memory, under the pressure of a benefit-period deadline. The regulation has not been read end-to-end since the last audit. That is exactly where documentation gaps hide.
RecertShield exists to close that gap with a single, exhaustive standard applied identically to every file.
45 of 100
sampled certification periods failed Medicare documentation requirements per a recent OIG audit
The benchmark
Measured against the letter of the regulation — subsection by subsection.
We do not summarize the law and hope. Every file is scored against a versioned rule pack tied to the exact text of 42 CFR Part 418 and the applicable Local Coverage Determination. These are the provisions each file is held to.
Recertification timing
The recertification date is verified to fall within each benefit period, computed deterministically — never estimated.
IDG note corroboration
Interdisciplinary-group clinical notes are cross-referenced to the physician narrative to ensure consistency and support for the terminal prognosis.
Face-to-face encounter
Documentation of the required face-to-face encounter with a hospice physician or nurse practitioner is present and dated within the required timeframe.
Notice of Election
The NOE is verified to have been filed within five calendar days of the election start date, with the election-statement addendum and non-covered-services notice present and correctly executed.
Local Coverage Determination
The file is checked against the agency's Medicare Administrative Contractor's LCD for any additional documentation requirements specific to the jurisdiction.
How a file is built
Intake to credentialed nurse reviewer release, with deterministic gates the AI cannot overrule.
AI extracts and drafts. Deterministic rules — running as code, outside the model — decide what is complete. A credentialed hospice compliance nurse reviewer certifies every release. That order is never reversed.
01
Documentation Gap Scan
Upload the initial certification, physician narrative, IDG notes, recertification docs, and NOE. We return a free completeness read: which regulatory elements and documentation you already have, and which are missing.
02
Evidence & narrative analysis
As your authorized clerical agent, we extract and organize the physician narrative, IDG notes, F2F encounter documentation, and election forms, and build a gap analysis against the 42 CFR Part 418 rule pack.
03
Grounded drafting
The eligibility file and audit-response package are drafted from your validated data and the regulatory rule pack into field-locked templates — no legal opinions, no invented facts.
04
Deterministic completeness gates
The physician narrative is checked for individualized language; the IDG notes are corroborated; the F2F encounter date is verified; the NOE filing date is confirmed; the LCD requirements are resolved. Any failure blocks release.
05
Credentialed nurse reviewer certification
A credentialed hospice compliance nurse reviewer reviews the exception queue and certifies the release. High-dollar or pattern-flagged files route to attorney review first.
06
Delivery
You receive the file: eligibility summary, narrative gap analysis, IDG corroboration log, F2F encounter checklist, NOE verification, LCD compliance checklist, and the audit-response package — ready for the agency to submit under its own name.
The bar we hold
Rigor you can measure.
100%
Nurse-reviewer-certified
No file ships without a credentialed human signature.
5 days
Standard SLA
From complete intake to certified file.
<1%
Critical-defect target
Tracked against a gold-standard file library.
4
Regulatory sources
42 CFR Part 418 · LCD · OIG audit patterns · UPIC guidance, every applicable file.
Why RecertShield
Built to be the most thorough option a hospice has.
Documentation-complete, by design
The deliverable is completeness itself — every regulatory element and documentation check accounted for or explicitly exception-coded. Nothing is left implicit.
Deterministic, not vibes
The gates that decide completeness are code, not a model's opinion. A drafting error cannot slip past a regulatory requirement.
In its lane, on purpose
We prepare documentation and run analyses as your clerical agent. We never provide medical advice, re-litigate clinical determinations, or submit claims.
Engagement
Flat fee, per patient-episode reviewed. No contingency, ever.
Simple, predictable, and aligned with a documentation standard — not a cut of any billed or recovered Medicare dollars.
- A free Documentation Gap Scan before you commit — see exactly what is missing.
- One flat fee per released Eligibility File & Audit-Response Package; disclosed pass-through costs for any external record retrieval.
- Optional fixed-fee attorney review for high-dollar or pattern-flagged files.
- Optional Census Monitoring Add-on for ongoing average-daily-census compliance tracking.
FAQ
Questions, answered precisely.
Is RecertShield a law firm?
No. RecertShield, a service of Your Deputy, Obuke LLC, provides documentation-completeness services. It is not a law firm, does not provide legal advice, and does not represent you in any legal matter. Attorney review is available and recommended for high-dollar or pattern-flagged files.
Do you re-litigate clinical determinations or submit claims?
Never. RecertShield does not re-litigate the clinical determination of terminal prognosis and does not submit claims to Medicare. The hospice agency remains the provider responsible for all clinical decisions and claim submissions.
What makes a file 'complete'?
Completeness is defined by the regulation: the signed, individualized physician narrative present; IDG notes corroborated; F2F encounter documented; NOE filed within five days; election addendum and non-covered-services notice present; and LCD requirements resolved. Deterministic gates enforce each one before release.
How fast is it?
The standard SLA is five business days from complete intake to a nurse-reviewer-certified file. The free Gap Scan is returned much sooner and tells you exactly what is still needed.
How are you priced?
A flat fee per released file, plus disclosed pass-through costs. No contingency and no percentage of any billed or recovered Medicare dollars.
See what's missing before it triggers a denial.
Start with a free Documentation Gap Scan. Send your certification and recertification documentation and we'll return a completeness read against every subsection of 42 CFR Part 418 and your applicable LCD.
Documentation-completeness service · not legal advice · the hospice agency submits every file.