• E-mail
• Print
• RSS
• Buy It Now
• Reprints

Improve your facility's medical necessity compliance

Health Care Auditing Strategies, June 1, 2005

This is an excerpt from a member only article. To read the article in its entirety, please login.

If there's one area of compliance the government will watch for years to come, you can bet on medical necessity.

CMS has vowed to lower the percentage of payments for services that don't meet Medicare's medical necessity standards. The latest CMS figures show that 17.2% of all improper payments in fiscal year 2004 (excluding inadequately documented claims) were due to bills for medically unnecessary procedures.

"With the heavy interest on reducing the fee-for-service error rate, there's no question that CMS is going to have to focus to a greater extent on medical-necessity issues. That means OIG probably will, as well. And that means provider and practitioner risk of whistleblowers reporting these cases will also increase," said Timothy P. Blanchard, Esq., a partner at McDermott Will & Emery, LLP, in Los Angeles.

Blanchard and Albert Bothe Jr., MD, executive director for the University of Chicago Practice Plan, spoke about the medical-necessity compliance risk during the Health Care Compliance Association's 2005 Compliance Institute in New Orleans in April.

This is an excerpt from a member only article. To read the article in its entirety, please login.

• E-mail to a Colleague
• Print
• RSS
• Archive
• Buy It Now
• Reprints / Permissions