Hospital manual.

  • United States Social Security Administration
Date:
1967]
Catalogue details

Licence: Public Domain Mark

Credit: Hospital manual. Source: Wellcome Collection.

    55/130 page 43
    fact met. The certification could, therefore, be entered or preprinted on a form the physician already has to sign; or a separate certification form could be used. 275. RECERTIFICATION FOR INPATIENT HOSPITAL SERVICES The recertification statement must meet the following standards: it must contain an adequate written record of the reasons for continued hospitalization, the esti- mated period of time the patient will need to remain in the hospital, and plans for posthospital care. The re- certification statement made by the physician has to _ meet the content standards unless, for example, all of the required information is included in progress notes, in which case the physician’s statement could indicate that the individual’s medical record contains the infor- mation required by the standards and that continued hospitalization is medically necessary. A physician who recertifies to the need for continued inpatient stay should use the same criteria that apply to the hospital’s utilization review committee. Where the basis for the recertification is the need for continued inpatient care because of the lack of extended care facility accommodations (§ 290.3), the recertification should so state. The physician should attempt on a continuing basis to place his patient in a participat- ing extended care facility as soon as a bed becomes available. : Recertifications are to be signed by the attending physician or a medical staff member with knowledge of the case. The hospital determines the form of the written record and the manner of obtaining timely recertifications. ‘Thus, the hospital is able to adopt a procedure for obtaining timely recertifications that suits it best. Where the requirements for the third or a subsequent recertification are satisfied by review of a stay of ex- tended duration, pursuant to the hospital’s utilization review plan, a separate recertification statement is not required. However, it is necessary to satisfy the recer- tification content standards. It would be sufficient if records of the utilization review committee show that consideration was given to the three items mentioned above—the reasons for continued hospitalization, esti- mated time the patient will need to remain in the hospi- tal, and plans for posthospital care. 276. TIMING OF RECERTIFICATIONS The first recertification is required no later than as of the 14th day of hospitalization. A hospital may, made earlier, or it may vary the timing of the first recertification within the 14-day period by diagnostic or clinical categories. A second recertification is required no later than as of the 21st day of hospitalization. Thereafter, sub- sequent recertifications must be made at intervals established by the utilization review committee (on a case-by-case basis if it so chooses), but in no event may the prescribed interval between recertifications exceed 30 days. The utilization review committee will be re- viewing long-stay cases and may be in the best position to decide when subsequent recertifications are needed. A hospital can, if it wishes, coordinate its physician certifications with the process of review by the utiliza- tion review committee of long-stay cases. At the option of a hospital, review of a stay of extended duration under the hospital’s utilization review plan may take the place of the third and any subsequent physician recerti- fications. (Such review may be the initial review, or a second or subsequent review of an extended-stay case by the utilization review committee. ) Where review of an extended-stay case by the utili- zation review committee is deemed to take the place of a physician recertification, it would be possible for the recertification to be made later than the specified day, because the review of an extended duration case may be made at any time within the 7-day period following the last day of the period of extended duration defined in the utilization review plan. Such a recertification will be treated as a delayed recertification, however, no explanation for the normal delay is required. 277. INPATIENT PSYCHIATRIC HOSPITAL SERVICES CERTIFICATION AND RE- CERTIFICATION The requirements for physician certification and re- certification for inpatient psychiatric hospital services are generally the same as for inpatient hospital services. However, the required content of the certification and recertification statements differs from the content of the statements required for inpatient hospital services. The certification should state that the inpatient psychiatric hospital admission was medically necessary, for either (1) treatment which could reasonably be ex- pected to improve the patient’s condition, or (2) diag- nostic study. The recertification should state (1) that inpatient psychiatric hospital services furnished since the previ- ous certification or recertification were, and continue to could reasonably be expected to improve the patient’s
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