Medical Necessity from the Lens of a Payor
January 27, 2021 11:00am MT
Learn more about this event
Establishing medical necessity can be difficult at times, but in many instances the payers have given specific information on what type of documentation and/or activity supports medical necessity. It is important for you to know and understand the differences between medical necessity and medical decision making. During this presentation, we will discuss some of the criteria for establishing medical necessity. We will also review specific clinical scenarios along with specific payer policies. Don’t miss your opportunity to learn more about what payers are looking for when reviewing your medical record.
Why is this topic important?
As the volume of claim denials increase, it is critical for us to know what steps must be taken to validate the reason for providing a service. The payers have medical policies in place to help them determine which conditions support certain procedures and treatment. You should be in tuned with those policies and be able to transfer those requirements to internal operations.
Who would benefit from this topic?
Coders, billers, CDI professionals.
What information or new skills will the attendee take away from this webinar?
Defining medical necessity from a payer perspective and learning how to incorporate payer requirements into your organization’s policies.
What's the presenter's background/expertise on this topic?
Leonta Williams and Wanda Register have over 30 years combined experience in medical coding, documentation, education, and claim support.
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