Corporate Compliance

Medical necessity important element of audits

Strategies for Health Care Compliance, June 1, 2009

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Every audit has unique components to check depending on whether you audit a certain department, a specific type of service, or a particular type of coding. But they all require the examination of medical necessity.

During CMS’ Recovery Audit Contractor program demonstration, auditors attributed 62% of overpayments to errors related to medically unnecessary services or settings, according to CMS’ 2008 report, Medicare Recovery Audit Contractor Program: An Evaluation of the 3-Year Demonstration.

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