decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Compliance / Reasonable and necessary services
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Article Overview
This compliance-focused article discusses how Medicare evaluates whether services meet the reasonable-and-necessary standard and what that means for physician billing and documentation. It is intended for providers, coders, and billing staff who need a high-level understanding of Medicare payment expectations and the kinds of records that may be requested to support a service.
Why This Topic Matters
Understanding the reasonable-and-necessary standard helps practices reduce payment risk and respond appropriately when Medicare requests support for billed services.
What You Will Learn
- How Medicare’s reasonable-and-necessary standard relates to physician ordering and billing
- Why documentation may be needed to support the appropriateness of a service
- How denial-related billing scenarios can arise in a compliance context
- What types of records may be requested to substantiate a service
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Compliance staff
- Practice managers
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