Medicare medical necessity rules have been arguably
the most effective outpatient cost control program
to date. Fundamental to their success is a reliance
on poor communication between prescribing providers
and third-party diagnostic service or treatment providers.
In order for pre-service medical necessity determinations
to be made so that Advance Beneficiary Notices (ABN)
can be obtained, prescribing providers must effectively
communicate diagnostic information to the third-party
provider.
This program is formulated to fit within the usual
hospital physician teaching formats such as Grand
Rounds presentations or community educational forums.
Attendees will learn to frame compliance within clinical
decision-making. They will leave with tools that prepare
them to adopt appropriate coding practices and to
provide the required documentation that justifies
Medicare medical necessity regulations.
The goals of this program are to:
- improve physician understanding of the role of
Medicare medical necessity rules
- educate physicians concerning compliance requirements
under medical necessity, and
- inform physicians about the reimbursement issues
that affect third-party diagnostic facilities.
Contact us for information
about the program
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