Admission Certification
  • Known also as : Pre-Admission Certification, Pre-Admission Review, Pre-Authorization, Pre-Certification
     
  • A method of assuring that only those patients who need hospital care are admitted.
     
  • This is a method of controlling and monitoring utilization by evaluating the need for service prior to the service being rendered. The practice of reviewing claims for inpatient admission prior to the patient entering the hospital in order to assure that the admission is medically necessary.
     
  • Certification can be granted before admission (preadmission) or shortly after (concurrent).
     
  • This refers to a decision made by the payer, MCO or insurance company prior to admission.
     
  • The payer determines whether or not the payer will pay for the service.
     
  • Most managed care plans require pre-certification.