Q&A: Inpatient Certification

May 24, 2016
Medicare Web

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.

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Ask the Expert, Patient status