medical necessity


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medical necessity

FDA-speak
A product is considered medically necessary, or to be a medical necessity, if it is used to treat or prevent a serious disease or medical condition, and if there is no other available source of that product or alternative drug or therapy judged by medical staff to be an adequate substitute. Patient "inconvenience" alone is an insufficient basis to classify a product as a medical necessity.

Managed care
The use of diagnosis codes to establish necessary preconditions for providing a service.
 
Medspeak
A general term referring to diagnostic procedures needed to detect a potentially treatable condition, or therapeutic modalities required by a particular condition.

medical necessity

Medical practice A general term referring to diagnostic procedures needed to detect a potentially treatable condition, or therapeutic modalities required by a particular condition
References in periodicals archive ?
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)?

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