CMS Provides Additional Guidance for Hospital Inpatient Certification and Admission Orders

Date posted: March 6, 2014

On January 30, the Centers for Medicare & Medicaid Services (CMS) released additional guidance for hospital inpatient certification and admission orders under the 2-Midnight Rule. According to the guidance, CMS requires the responsible physician, or a physician who has knowledge of the case to sign the certifications and recertifications.  CMS does not require specific procedures or forms for certification and recertification statements, and providers may adopt a method that permits verification.  

Further, a qualified ordering practitioner may not delegate the inpatient admission order to an individual who is not authorized by the state to admit a patient, or has not been granted admitting privileges by the hospital’s medical staff.  However, residents and certain non-physician practitioners may write inpatient admission orders if the ordering practitioner approves and accepts responsibility for the admission decision by counter-signing the order prior to discharge.  Additionally, verbal orders must identify the qualified admitting practitioner, and must be countersigned by the ordering practitioner promptly and prior to discharge. 

CMS also announced it is requiring Medicare Administrative Contractors to re-review all claims denied to date under the probe and educate process to ensure that the decisions and subsequent education given were consistent with the updated guidance released by CMS related to hospital inpatient order and certification requirements on January 30, 2014.

The CMS guidance is available at:

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Downloads/IP-Certification-and-Order-01-30-14.pdf.

The CMS guidance related to the probe and education re-review process is available at:

http://cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/InpatientHospitalReviews.html.

Centers for Medicare & Medicaid Services.  “Hospital Inpatient Admission Order and Certification.”  30 Jan. 2014.

“Inpatient Hospital Reviews.  Updates 2-24-14.” Feb. 24, 2014. Centers for Medicare & Medicaid Services. 26 Feb. 2014.

<http://cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/InpatientHospitalReviews.html>.

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