Q&A: Inpatient Certification

Q: Who can complete inpatient certification?

A: CMS designates the following individuals to have sufficient knowledge of the case to make the inpatient certification:

• The attending physician of record or a physician on call for him or her
• A surgeon responsible for a major surgical procedure on the patient or a surgeon on call for him or her
• A dentist (in limited circumstances)
• A physician member of the hospital staff (e.g., utilization case, entered a full certification statement containing all elements, and is making the certification on behalf of a nonphysician ordering practitioner who cannot himself or herself make the certification review physician) if he or she has reviewed the case, entered a full certification statement containing all elements, and is making the certification on behalf of a nonphysician ordering practitioner who cannot himself or herself make the certification

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

Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.