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Medical Necessity from the Lens of a Payor

Presenter Leonta Williams, CPC, CPCO, CRC, CEMC, CHONC
Broadcast Date 1/27/2021
Time 10:00am PT / 11:00am MT / 12:00pm CT / 1:00pm ET
Presentation Length 60 minutes
Price $65 (Non-members $85)
Medical Necessity from the Lens of a Payor Webinar

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.

Leonta Williams, CPC, CPCO, CRC, CEMC, CHONC

About The Author

Leonta Williams, CPC, CPCO, CRC, CEMC, CHONC

Director of Medical Coding, Georgia Cancer Specialists, and Healthcare Management Consultant, Karna, LLC
Lee Williams has more than 15 years health information management (HIM) experience as a coding director, auditor, educator, trainer, practice manager, and mentor. Williams has provided coding leadership and oversight on programs sponsored by the Centers for Disease Control and Prevention National Center for Health Statistics, the U.S. Consumer and Product Safety Commission, and Industrial Economics, Inc. She has extensive experience in regulatory compliance, CDI, and risk management. Williams is a frequent speaker and is published at the national level. She is founder of the Covington, Georgia, local chapter and serves as the 2018 president.

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Two ways to register for this event
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