Avoid medical necessity barriers to getting paid for office visits

Article Overview

This article discusses why office visits can be denied when payers do not consider the documented reason for the visit medically necessary, with emphasis on ophthalmology practice scenarios. It contrasts routine versus problem-oriented encounters, notes differences between commercial payer and Medicare handling, and highlights the importance of capturing symptoms, chief complaints, and diagnoses in the record. The article is useful for coders, billers, technicians, and ophthalmology practices that want to reduce preventable denials and patient billing disputes.