The CERT contractor has seen increased denials of SNF inpatient stays due to missing or incomplete physician certification statement of medical necessity. Certification of medical necessity of inpatient skilled nursing services has been a longstanding CMS requirement.
MLN Matters article SE1428 describes details as a guide for physicians and SNFs to document certification by the physician regarding the medical necessity of the skilled nursing inpatient stay.
An acceptable certification statement must contain:
An acceptable recertification statement must contain:
There is no specific format or procedure for documentation of the certification, but this certification is required to be in the patient’s medical record.
The following are the required timeframes for physicians or NPPs to document the certification or recertification statement(s):