Failure to Certify or Recertify for Hospital Services

10.1 - Failure to Certify or Recertify for Hospital Services (Rev. 1, 09-11-02) If a hospital fails to obtain the required certification or recertification statements in an individual case, program payments may not be made in that case. If the hospital's failure to obtain a certification or recertification is not due to a question as to the necessity for the services, but rather to the physician's refusal to certify based on other grounds (e.g., he/she objects in principle to the concept of certification and recertification), the hospital may not bill the program or the beneficiary for covered items or services. The provider agreement precludes the hospital from charging the patient for covered items and services.