Medical Necessity

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Medical Necessity

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Author : Daniel Skinner
language : en
Publisher: U of Minnesota Press
Release Date : 2019-12-24

Medical Necessity written by Daniel Skinner and has been published by U of Minnesota Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2019-12-24 with Medical categories.

How the politics of “medical necessity” complicates American health care The definition of medical necessity has morphed over the years, from a singular physician’s determination to a complex and dynamic political contest involving patients, medical companies, insurance companies, and government agencies. In this book, Daniel Skinner constructs a comprehensive understanding of the politics of defining this concept, arguing that sustained political engagement with medical necessity is essential to developing a health care system that meets basic public health objectives. From medical marijuana to mental health to reproductive politics, the concept of medical necessity underscores many of the most divisive and contentious debates in American health care. Skinner’s close reading of medical necessity’s production illuminates the divides between perceptions of medical need as well as how the gatekeeper concept of medical necessity tends to frame medical objectives. He questions the wisdom of continuing to use medical necessity when thinking critically about vexing health care challenges, exploring the possibility that contracts, rights, and technology may resolve the contentious politics of medical necessity. Skinner ultimately contends that a major shift is needed, one in which health care administrators, doctors, and patients admit that medical necessity is, at its base, a contestable political concept.

Coding For Medical Necessity Reference Guide First Edition

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Author : AAPC
language : en
Publisher: AAPC
Release Date : 2020-03-18

Coding For Medical Necessity Reference Guide First Edition written by AAPC and has been published by AAPC this book supported file pdf, txt, epub, kindle and other format this book has been release on 2020-03-18 with Medical categories.

Master coding concepts related to medical necessity and report compliant codes for your services. Revenue loss, rework, payback demands—how much are medical necessity errors costing your practice? And that’s to say nothing of potential civil penalties. Get medical necessity wrong and it’s considered a “knowingly false” act punishable under the FCA. Stay liability-free and get reimbursed for your services with reliable medical necessity know-how. AAPC’s Coding for Medical Necessity Reference Guide provides you with step-by-step tutorials to remedy the range of documentation and coding issues at the crux of medical necessity claim errors. Learn how to integrate best practices within your clinical processes—including spot-checks and self-audits to identify problems. Benefit from real-world reporting examples, Q&A, and expert guidance across specialties to master coding for medical necessity. Learn how to lock in medical necessity and keep your practice safe and profitable: Avoid Medical Necessity Errors with CERT Smarts Rules to Improve Provider Documentation Denials? Pay Attention to Procedure/Diagnosis Linkage Nail Down the Ins and Outs of Time-based Coding Expert Guidance to Fend Off RAC Audits and Denials Beat E/M Coding Confusion with Payer Advice Improve Your ABN Know How with This FAQ

Medical Necessity From Theory To Practice

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Author : United States. Congress. Senate. Committee on Health, Education, Labor, and Pensions
language : en
Publisher:
Release Date : 1999

Medical Necessity From Theory To Practice written by United States. Congress. Senate. Committee on Health, Education, Labor, and Pensions and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1999 with Political Science categories.

Medical Necessity In Private Health Plans

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Author :
language : en
Publisher:
Release Date : 2003

Medical Necessity In Private Health Plans written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2003 with Health insurance categories.

Redefining Medical Necessity

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Author : Ryan Abbott
language : en
Publisher:
Release Date : 2015

Redefining Medical Necessity written by Ryan Abbott and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2015 with categories.

The American health care system is plagued by high costs and poor public health outcomes, due in part to the overuse of costly diagnostic tests and treatments. In 2009, the Institute of Medicine estimated that unnecessary care wastes 750 billion dollars a year, equivalent to about 30% of health care spending. Moreover, overtreatment can directly harm patients as a result of surgical complications, drug toxicity, and hospital-acquired infections. Yet while the problem of medical waste has long been recognized, solving the problem has proven elusive. In part, this is due to perverse economic incentives for physicians and hospitals, which still primarily receive reimbursement on a fee-for-service basis. Providers are financially motivated under this system to generate a higher volume of invasive procedures independent of their likely benefits. Patients generally lack the information needed to decline unnecessary services, even when they wish to actively share in medical decision-making, and a strong cultural bias pushes both patients and physicians to “do more,” even when evidence suggests that doing more may result in harm. In the 1990s, managed health care organizations attempted to rein in health care waste by stringently reviewing and prospectively denying payment for unnecessary tests and treatments, but that experiment was a political failure. Similarly, attempts to reduce overuse by shifting financial risk directly onto providers through capitated payment mechanisms have had limited success. The ability of these mechanisms to limit waste is compromised by the real or perceived incentive to also reduce spending on appropriate care. We propose a new conception of medical necessity that will reduce inappropriate care by allowing informed consumers to actively participate in decisions about their medical care. Where evidence-based guidelines are available, medical necessity should be determined on the basis of an objective, multi-level Matrix of Appropriateness rather than the subjective binary decision of an insurance company's medical reviewer. Such Matrices have already been created by systematically combining published evidence with expert judgment to create clinically detailed, evidence-based, multi-level medical necessity ratings for elective procedures based on individual patient characteristics. In our proposed system, if a patient desires a service proposed by a physician under clinical circumstances that receive low medical necessity ratings, the third-party payer would offer to cover the service but at a sliding copayment scale imposing greater patient cost sharing based on the service's appropriateness. This would preserve patient choice while discouraging the overuse of costly treatments that provide little marginal value, reducing medical waste and improving the overall value of medical care.

Documenting Medical Necessity A Practical Guide For Home Health

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Author :
language : en
Publisher:
Release Date : 2015

Documenting Medical Necessity A Practical Guide For Home Health written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2015 with categories.

Defying Definition Medical Necessity And Health Policy Making

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Author :
language : en
Publisher:
Release Date : 1996

Defying Definition Medical Necessity And Health Policy Making written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1996 with Medical care categories.

Medical Necessity

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Author :
language : en
Publisher:
Release Date : 2005

Medical Necessity written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2005 with Health services accessibility categories.

Determining Medical Necessity

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Author : California HealthCare Foundation
language : en
Publisher:
Release Date : 1999*

Determining Medical Necessity written by California HealthCare Foundation and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1999* with categories.

Medical Necessity And Its Impact On Medi Cal Hospital Inpatient Utilization

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Author : California. Medical Care Statistics Section
language : en
Publisher:
Release Date : 1988

Medical Necessity And Its Impact On Medi Cal Hospital Inpatient Utilization written by California. Medical Care Statistics Section and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1988 with Hospital care categories.