Q&A: Content requirements for inpatient certification

February 3, 2020
Medicare Web

Q: When a physician needs to certify an inpatient stay of 20 days or more, do we need to use a specific form for the certification? Or can we submit other documentation such as the physician's notes from the medical record?

A: The inpatient certification may be made with a specific separate certification form or constructively through the forms, notes, or records signed by the certifying physician. If other forms, notes, or records are the basis of the certification, the physician must sign a separate statement that inpatient services are, or continue to be, medically necessary as documented in the record. The separate signed statement does not need to designate which forms, notes, or records contain the required information as long as it can be verified.

There are three elements to the certification:

  1. The reason for continued hospitalization of the patient
  2. or the special or unusual services for cost outlier cases
  3. The estimated time the patient will need to remain in
  4. the hospital
  5. Plans for postdischarge care, if appropriate

For more information, see the Patient Status Training Toolkit for Medicare Utilization Review, Second Edition.