- Medicare requires certification and re-certification by a physician for inpatient psychiatric services to Medicare beneficiaries. A physician must provide the initial certification at the time of admission, or as soon thereafter as is reasonable and practicable, documenting that the inpatient psychiatric hospitalization is reasonable and medically necessary for treatment expected to improve the patient’s condition, or for a diagnostic study. A physician must provide the first re-certification no later than the 12th day of hospitalization. Subsequent re-certifications are to be at intervals established by the utilization review committee (on a case-by-case basis, if it so chooses), but no less frequently than every 30 days that the patient continues to need active inpatient treatment, on a daily basis.
- For additional guidance on medically necessary admission criteria and documentation requirements for recertification and defining ‘active treatment’, refer to the CMS’ Medicare Learning Network Inpatient Psychiatric Facility Prospective Payment System Fact Sheet Series, and the CMS’ Publication 100-04, chapter 4, section 10.9 – Inpatient Psychiatric Facility Services Certification and Recertification on the CMS Inpatient Psychiatric Facility PPS webpage.
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