Health Information Management

Topic: Use 'what's in it for me?' approach to convey importance of medical necessity to physicians

HIM-HIPAA Insider, August 14, 2007

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Some physicians are of the opinion that whatever they write on a patient's record or order for the patient is automatically accepted without question by third-party payers and peer review organizations. This may have been true in the past, but today's third-party payers demand that you justify services. Physicians should understand that there are many regulations and guidelines that all healthcare providers must follow in order to show that they are maintaining proper protocol and quality-of-care standards.

Physicians, as well as healthcare facilities, are being monitored and profiled regarding comparative efficiency and effectiveness of care being provided. Over the next few years, this information will become public, and patients will be encouraged to compare their providers with others. This will allow them to select their providers on the comparative quality-of-care given to their patients. Communicating with physicians about this information will help them understand that queries are meant to help them become aware of the accepted standards for documented quality, efficiency, and effectiveness of care. This tactic may encourage them to be more cooperative and accepting of documentation querying and pathways/protocols, as well.

Editor's note: This article was adapted from a recent issue of JustCoding.com. Subscribers to this newsletter can log-on for more information by clicking here.



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