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Fundamentals of Medical Necessity Documentation

Understanding medical necessity and the documentation of it is important to both the provider and payer, and it is crucial that documentation is done correctly.

It is imperative in today's environment that there is a clear understanding of what is meant by medical necessity. It is a crucial element for a health care provider to not only be paid and to be paid correctly, but to avoid an allegation of an overpayment should Medicare, or another payer, request supporting documentation for claims submitted. Everyone in the practice or clinic needs to be educated on how important a chief complaint is and what it means to have precise documentation. Coders and billers submitting claims as well as physicians and non-physician practitioners documenting services ordered or provided all need to have a good grasp of how payers make a medical necessity determination. This information will review recent findings from CMS contractors on what they are looking for in verifying medical necessity. With so many different types of audits that can happen, we need to be armed and ready with knowledge on how to apply these findings. It is essential for proper reimbursement but also how to determine what documentation to submit when responding to a payer's request for records.

Runtime: 94 minutes
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Why Lorman?

Over 32 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Agenda

Defining the Difference Between Medical Necessity and Medical Decision Making

How to Properly Document Clinical Indictors Versus Having a Problem List and Why This May Be an Audit Trigger

Discuss Tips on How to Avoid Denials and Rejects

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Why Lorman?

Over 32 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Credits

OnDemand Webinar

This course was last revised on September 24, 2019.

Call 1-866-352-9540 for further credit information.

  • AHIMA 1.5 including External Forces 1.5
     
  • This program has been approved for 1.5 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.
     

This program does NOT qualify, nor meet the National Standard for NASBA accreditation.

Audio & Reference Manual

This program does NOT qualify, nor meet the National Standard for NASBA accreditation.

MP3 Download

This program does NOT qualify, nor meet the National Standard for NASBA accreditation.

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More Program Information

Why Lorman?

Over 32 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Faculty

Rhonda Granja, B.S., CMC, CMA, CPC, CMOM

Rhonda Granja, B.S., CMC, CMA, CPC, CMOM

Rhonda Granja Consulting

  • Independent medical consultant and PMI faculty member
  • Speaker at the 2013-2015 PMI National Conference
  • Speaker at the 2014 AMBA National Conference
  • McVey Seminar leader
  • Panel speaker for The Coding Leader
  • Panel speaker at Compliance World
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Why Lorman?

Over 32 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

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Product ID: 404360
Published 2019
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