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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.
Authorization granted to the patient for hospital admission after a review of the patient's proposed need for inpatient services. In some settings, if certain set criteria are not met, then the admission is not allowed.
See also: certification