E]xternal-review decisions are independent determinations of medical necessity
that do not supersede contractual definitions of medical necessity
, wrote Justice Natalie Hudson for the court.
A district court in Washington, DC, has held that alleging a laboratory's failure to independently verify the medical necessity
of tests ordered by treating physicians is sufficient to survive a Rule 12(b) challenge to a federal False Claims Act claim.
Adult Medi-Cal beneficiaries who meet the medical necessity
criteria contained in the California Code of Regulations (CCR), Title 9 Section 1830.
The new resource not only provides the basics of dental-medical cross-coding, it also demonstrates how to use it to develop effective letters for explaining the medical necessity
of dental treatment, forging closer working relationships with physicians and expediting insurance reimbursement.
Federal auditors have been ramping up their review of hospital claims for medical necessity
and experts advise that hospitals take an equally vigorous approach to dealing with the increased attention.
16 August 2010 - US-based health information technology and services company Ingenix today announced it is acquiring Executive Health Resources, a provider of medical necessity
compliance and physician medical management solutions for hospitals.
For most hospitals, there are three main areas in the coding and billing process that represent the biggest opportunities to increase cash flow and reduce revenue variability: medical necessity
, claims compliance and denials analysis.
Circumcision--the surgical removal of the foreskin on the penis, usually soon after birth--is rarely considered a medical necessity
and carries a risk of surgical complication.
With a lot of work, this might lead to standardization in the approach to determination of medical necessity
and a lot of kudos from our practicing colleagues.
The group's executive director, Peter Ryan, says Medicare only covers abortion in cases of medical necessity
com division, acquired by CodeCorrect in August, 2005, the company provides maintenance, management and enterprise-wide tools, medical necessity
verification, regulatory content, data analytics, coding intelligence, and content links for access to related information.
Q: If a resident on enteral feedings starts out on the gravity method of administration but later moves to the pump method, how does that affect the certificate of medical necessity
currently on file with the durable medical-equipment regional carrier (DMERC)?