Corporate Compliance

Medical necessity important element of audits<

Health Care Auditing Strategies, May 1, 2009

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Interpretation of medical necessity gets tricky, depending on the case. If a patient needs open heart surgery, documentation of the patient’s condition and symptoms makes the need for surgery obvious, Corrato says. However, if the case involves a patient with back pain, this condition is more vague.

“It’s not always black and white in terms of what is reasonable for diagnosis and treatment,” Corrato says. “Things become gray—so what do we look to?”

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