CMS Issues Guidance Clarifying Part A Inpatient Medical Review Criteria Policy

The Centers for Medicare & Medicaid Services has issued guidance interpreting its new requirements for admission and medical review criteria for hospital inpatient services under Medicare Part A.

The guidance document, released Sept. 5, clarifies a policy that requires physician certification of the medical necessity of inpatient services as a condition of Medicare payment. According to the guidance, the order to admit as an inpatient “is a critical element of the physician certification, and is therefore also required for hospital inpatient coverage and payment under Part A.”

Specifically, the document clarifies the types of practitioners who may furnish orders for ...