decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Medical Necessity / Overview
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Article Overview
This article explains the general concept of medical necessity as it relates to coding and billing. It is aimed at coders, billers, and healthcare staff who need a broad understanding of how medical necessity ties together diagnosis support, standards of care, patient convenience concerns, and documentation expectations.
Why This Topic Matters
Medical necessity is a core concept in claim review and reimbursement. Understanding the broad criteria discussed here helps readers recognize why some services are supported and others may be questioned during billing review.
What You Will Learn
- The general concept of medical necessity in medical billing
- How service purpose relates to diagnosis or treatment support
- Why accepted professional standards matter in coverage review
- Why convenience-driven services may be scrutinized
- How service level and documentation can affect claim support
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Clinical office staff
- Healthcare administrators
Codes Discussed
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