Corporate Compliance

Note: Determining inpatient medical necessity for procedures

Medicare Insider, February 15, 2011

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Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.

CMS was very quiet during the past week. That tends to make me a little nervous – you know the old saying… “The calm before the storm.”  Anyway, I was recently asked a question regarding the determining medical necessity for inpatient admissions for surgery. I thought I would share this information with you, especially since some of the RACs have really ramped up these types of reviews. Determining the medical necessity of an inpatient admission can be a complex process so we have to look at several different places for CMS guidance.

Continue reading Debbie's note on the MedicareMentor Blog.



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