CMS Pub. 100-01, ch. 4, § 10.8.1

For services furnished to beneficiaries admitted on or after January 1, 1970, the initial

certifications are required no later than as of the 12th day of hospitalization. A hospital

may at its option, provide for the certification to be made earlier, or it may vary the

timing of the certification within the 12-day period by diagnostic or clinical categories.

The first recertification is required no later than as of the 18th day of hospitalization.

Subsequent recertifications must be made at intervals established by the UR committee

(on a case-by-case basis), but in no event may the interval between recertifications

exceed 30 days.

The UR committee will be reviewing long-stay cases and may be in the best position to

decide when subsequent recertifications are needed.

A hospital can, if it wishes, coordinate its physician recertifications with the process of

review by the UR committee of longstay cases not subject to PPS, and for PPS day-outlier cases. At the option of the hospital, review of a stay of extended duration under

the hospital's utilization review plan may take the place of the second and any subsequent

physician recertifications. (Such review may be the initial review, or a second or

subsequent review of an extended case by the UR committee.)

Where review of an extended stay case by the UR committee is deemed to take the place

of a physician recertification, it would be possible for the recertification to be made later

than the specified day, because the review of an extended duration case may be made at

any time within the 7-day period following the last day of the period of extended duration

defined in the utilization review plan. Such a recertification will be treated as a delayed

recertification; however, no explanation for the normal delay is required.