Tag:
medical necessity
Latest Headlines
Latest Headlines
AHA: Hospitals appeal RAC denials with 77% success
Hospitals reported $355 million in denied claims between the first quarter of 2010 and the third quarter of 2011, according to the quarterly RACTrac survey from the American Hospital Association
Medical necessity, not patient convenience, should drive inpatient stay, CMS warns
The perennial issue of medical necessity makes a grand appearance in recent CMS guidance you may have missed. The agency sends a clear message: A patient's convenience or personal needs should not
Medical necessity not just a 'hospital thing'
Even though the majority of diagnostic tests and treatments ordered by physicians are performed and billed by someone else, physicians' perception of medical necessity "being a hospital thing only"
CMS 'complex reviews' on the way by August/September
So, everyone's been bracing themselves for full-bore audits by Recovery Audit Contractors--but soon the anticipation will end. CMS has already begun automated reviews of claims to detect simple,
Court says states can decide medical necessity under Medicaid
A new decision by a federal appeals court has concluded that physicians don't have sole discretion in determining what's medically necessary treatment for children with Medicaid coverage. The
