Tip: Medical necessity appeals: Include detailed patient information
Patient Access Weekly Advisor, July 2, 2008
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The most compelling aspect of a medical necessity appeal will be that of patient medical records. Therefore, use details when describing the following points in your letter:
· Relevant history and physical, SOAP, and Clinical Pathway or Treatment Plan information
· Previous medication and treatment efforts (including side effects, if applicable, and effectiveness or lack thereof) and patient’s compliance history
· Current medications and treatment efforts
· Related hospitalizations (indicating frequency, duration, and dates of recent hospitalizations related to condition)
· Risk factors—life or limb threatening nature of patient’s condition
Note: This tip was featured in Appeals Toolkit, by Tammy Tipton. To learn more about this book, click here.
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