Certified Inpatient Coding (CIC) Practice Exam

Who is responsible for requesting pre-certification for a planned hospital admission?

1. Patient

2. Provider or facility rendering service

3. Admitting office

4. Policyholder

The correct answer is: Provider or facility rendering service

The responsibility for requesting pre-certification for a planned hospital admission typically falls on the provider or facility rendering the service. This is because the provider or facility is directly involved in the patient's care and is aware of the medical necessity for the admission. They have the necessary information regarding the patient's condition and the specifics of the planned procedure or treatment, allowing them to effectively communicate this to the insurance company or payer. Pre-certification is a process intended to confirm that the planned services are authorized by the insurance policy before the admission takes place. By coordinating this during the admission process, the provider ensures compliance with the payer’s requirements and helps manage the patient’s insurance coverage effectively. While the patient, admitting office, and policyholder may have roles in the admission process, they typically do not perform the actual request for pre-certification as directly as the provider or facility.