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preadmission certification

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preadmission certification
[prē′ədmish′ən]
a system whereby physicians are required to obtain advance approval for nonemergency admission of Medicare, Medicaid, and managed care patients to hospitals, as well as most third-party payers. The system is intended to determine whether the patient can be treated as an outpatient or in another, less expensive manner than hospitalization. Emergency admissions require post hoc approval. Also called precertification.


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For example, techniques such as preadmission certification and second surgical opinions are widespread among indemnity plans.
The insurer usually charges the employer for utilization management services, including preadmission certification, concurrent review, and retrospective analysis of claims, to "manage" providers and control their tendencies to treat patients with too many services.
We also introduced utilization management programs like preadmission certification and mandatory second surgical opinions.
 
 
 
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