What is the purpose of Preadmission Certification?

Preadmission Certification serves a critical role in the revenue cycle management and healthcare delivery processes by focusing on the review of medical necessity prior to a patient’s admission to a healthcare facility. This review ensures that the services proposed align with established guidelines and criteria set forth by insurers or regulatory bodies.

By confirming medical necessity beforehand, Preadmission Certification helps prevent unnecessary admissions that may not be covered by insurance, thus minimizing the financial risk for both the patient and the healthcare provider. It also streamlines the admission process by ensuring that all required documentation is in place and that the services planned are justified based on the patient's medical condition.

In contrast, while authorization of outpatient procedures, cost assessments post-treatment, and patient education are important aspects of healthcare management, they do not capture the specific goal of Preadmission Certification, which is primarily centered on validating the need for inpatient services before they occur.