Medical necessity is a term that holds different meanings for different parties in the healthcare industry. For healthcare providers, it is about the patient's clinical needs, while for insurance payers, it revolves around coverage policies and guidelines.
Medicare defines medical necessity as:
“No payment may be made under part A or part B for any expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member … or for the prevention of illness, and in the case of hospice care, which are not reasonable and necessary for the palliation or management of terminal illness.”
It is essential to understand these definitions and how they apply to each patient's unique circumstances. Join us for an in-depth webinar by industry expert speaker Toni Elhoms, CCS, CRC, CPC, AHIMA-Approved ICD10-CM/PCS Trainer, where she will explore payer definitions, guidelines, and policies, including Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs).
Webinar Objectives
This session aims to bridge the gap between healthcare providers' and payers' perspectives on medical necessity. Attendees will:
Webinar Agenda
Webinar Highlights
Who Should Attend
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