The physician certification or recertification statement must be based on a current evaluation of the patient’s condition.
For services continued over a period of time or for a day outlier case, or for a PPS cost outlier case a physician must certify or recertify the continued need for the services at specified intervals. A certification or recertification statement must be signed by the attending physician responsible for the case or by another physician who has knowledge of the case and is authorized to do so by the attending physician, or by a member of the hospital’s medical staff with knowledge of the case. Availability of out-of-hospital facilities and services which will assume continuity of care. Outlier cases certification was required no later than1 day after the hospital reasonably assumes that the case meets the established outlier criteria, or no later than 20 days into the hospital stay, whichever is earlier. Psychiatric and tuberculosis hospitals (which are excluded from PPS) are required to obtain a physician certification on admission.
Hospitals do not transmit physician certification and recertification statements to the intermediary or to CMS.
The hospital must itself certify on the appropriate billing form that the required physician certification and recertification statements have been obtained and are on file. This entry was posted in Administration, Audit, Auditor, Care Management, Case Management, Case Manager, Certification, Clinical Resource Management, Clinical Social Worker, CMS, Compliance Officer, Consulting, Federal Register, Outlier, Patient, Post-acute, Post-discharge, reCertification, Short term Acute care hospital, Transmittal, Utilization Review and tagged Certification, medical necessity, Outlier, physician certification.


The Commission for Case Manager Certification (CCMC) recently installed a new slate of officers for the 2014-2015 years.
Demoratz has more than 30 years’ experience as a professionally trained social worker, where he worked with a catastrophically ill and injured patient population. Reach out to the author: contact and available social following information is listed in the top-right of all news releases. Event details may change at any time, always check with the event organizer when planning to attend this event or purchase tickets. The providers agreement precludes the hospital from charging the patient for covered items and services. Michael Demoratz, PhD, LCSW, CCM, and Director of Special Projects at Amada Senior Care, was among the commission’s nine newly elected members.
As a nationally recognized subject-matter expert on end-of-life care, he has presented at hundreds of conferences and published numerous articles on end-of-life, bereavement, pain management and catastrophic case management.
We provide nurturing, compassionate, non-medical, in-home care and guide families through the many senior housing options available for assisted living. It will energize your nursing career, harness your intuitive vision, and reclaim your energy and passion, while offering you a career of uncompromising integrity.This continuing education workshop, held in McLean, VA, right near the Tysons Corner Mall, will highlight the history of case management, divulge how to apply case management processes to actual cases, and name public and private health care systems with needs for case management.


Michael said he is extremely excited about this opportunity, and looks forward to serving the case management community in his new capacity. Michael currently works with Amada Senior Care as both a licensed clinical social worker and certified case manager.
We also offer expertise in handling long-term care insurance claims and in certain forms of government aid, including Veterans Aid and Attendance Benefits. At Amada, he has assisted in developing special technologies and in further developing case management services - raising the bar in the non-medical home care setting to allow seniors the best opportunity to successfully age in place.
Headquartered in San Clemente, California, Amada was founded in 2007, and is currently assembling an elite team of franchise partners to expand our business on the national level.



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