1. Certification by a provider to an insurance carrier that a medical service or procedure is medically necessary because of the patient’s condition. 2. Form required by Medicare that allows the patient to use certain durable medical equipment prescribed by a physician or one of the physician’s staff. 3. In Medicare fraud, to complete a CMN for patients not personally and professionally known by the physician.

Document that is required for an independent medical expert to review a patient’s medical record and certify that a claim has merit before a formal medical liability lawsuit is filed.

Document of approval issued by a state or government agency that legally allows an organization or health care institution to construct or modify a health care facility, incur a major capital expenditure, obtain expensive medical equipment, or offer a new or different health service. An investigation is done before receiving the CON to make sure the facility or service meets the needs of those for whom it is intended. Also referred to as planning approval.

Document issued to a laboratory to perform only waived tests. These are simple examinations or procedures that use methodologies that are so easy and accurate that the likelihood of erroneous results is negligible and poses no reasonable risk of harm to the patient if the test is performed incorrectly.

Amendment or supplement to the certificate of insurance.

1. Statement issued by a board or association verifying that a person meets professional standards. 2. Hospital certification means that a hospital has passed a survey done by a state government agency. Although it is similar, it is not the same as being accredited. Certification is usually applied to individuals and accreditation to hospital facilities. Note that Medicare only covers care in hospitals that are certified or accredited. See accreditation. 3. Approval by an insurance payer’s case manager to continue a patient’s care for a certain number of days or visits. 4. In home health plan certification, the physician receives, reviews, adjusts treatment, documents the plan in coordination with the care of the home health agency, and then bills for this service. For subsequent plan adjustment, see home health plan recertification.

Attestation by the patient’s attending physician on admission and at stated intervals of the need for hospitalization and continued stay in the facility.

Certification awarded to a person after appropriate training and passing a certification examination administered by the Alliance of Claims Assistance Professionals, Inc.

Individual who has obtained appropriate training, met experience prerequisites, and passed a national certification examination administered by a professional coding association.

Title received by a person after appropriate training and successfully passing a national certification examination administered by the American Health Information Management Association for hospital-based coding.