decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Physician Practice Model Compliance Plan / Specific Risk Areas / Reasonable and Necessary Services
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Article Overview
This compliance-focused article explains the Medicare concept of reasonable and necessary services and why it matters when physicians order and bill for tests or other care. It is aimed at physician practices, billing staff, and compliance professionals who need to understand the general documentation expectations tied to Medicare payment and denials. The discussion centers on broad Medicare billing standards, supporting records, and practice readiness when payment is reviewed.
Why This Topic Matters
Understanding the reasonable-and-necessary standard is essential for avoiding avoidable denials and for supporting billed services with appropriate documentation during Medicare review.
What You Will Learn
- How Medicare’s reasonable-and-necessary standard affects physician billing
- Why documentation matters when supporting the appropriateness of services
- When a denial may still be relevant for coordination with another payer
- What types of records may be used to support a billed service
Who Should Read This
- Physicians
- Physician practice managers
- Medical coders
- Medical billing staff
- Compliance professionals
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