Training Tool: Medical necessity
Editor’s note: This training tool is provided by Khristine Anderson, training and data integrity specialist at Baptist Health South Florida, which includes seven hospitals in the Miami area. Baptist uses the following script for Medicare compliance and documenting medical necessity, which Medicare defines as services or items reasonable and necessary for the diagnosis or treatment of illness or injury. A provider who bills Medicare for services that Medicare deems not medically necessary can be prosecuted for fraud. This script is only a guide; departmental protocols should be followed for all circumstances not covered.
About the Author: Dom Nicastro is a senior managing editor for HCPro, Inc.’s revenue cycle division. He manages the Patient Access Resource Center and develops training, management, and compliance products for the company’s editorial team in the areas of:
• Revenue cycle
• HIPAA
• Corporate Compliance
• Materials Management
• Patient Access
• Patient Financial Services.
Dom is the former editor of the Gloucester Daily Times, where he led the paper to the New England News Association Newspaper of the Year in 2005 and a runner-up for the same award by the New England Press Association in 2007.