Advanced Search

Medicare Compliance & Reimbursement

Reader Question:

How Do Different Payers' Define Medical Necessity?

Published on Thu Aug 01, 2019

Question:  Recently, we had a few claims denied that really surprised both our clinical and billing staff. The payers said the services rendered by one of our physicians were not “medically necessary.” I’m sure the provider thought the services were medically necessary — otherwise he wouldn’t have performed them. What definitions are payers using to determine whether a service or [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Medicare Compliance & Reimbursement

View All