Health Information Management

Pay-per-view: Medical necessity is key to the E/M visit level

APCs Insider, June 10, 2011

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by Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS, CCDS

Medical necessity governs provision of all healthcare services, regardless of reimbursement source. But the concept of medical necessity is gradually assuming a different perspective as payers migrate from a fee-for-service system to one that incorporates provider financial risk sharing and increases financial responsibility for effectively and efficiently managing defined patient populations.

In the long term, this enhanced financial responsibility makes it even more important to capture and report the medical necessity of all provided services. Proper capture of medical necessity for facility ED services, as well as clinic services, is paramount to demonstrating value and efficiency in the healthcare delivery process.

Continue reading “Medical necessity is key to the E/M visit level” on HCPro’s website. Subscribers to Briefings on APCs have free access to this article in the June issue.



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