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Medicare Compliance & Reimbursement

Reader Question:

How Do Different Payers' Define Medical Necessity?

Published on Thu Aug 01, 2019

Question:  Recently, we had a few claims denied that really surprised both our clinical and billing staff. The payers said the services rendered by one of our physicians were not “medically necessary.” I’m sure the provider thought the services were medically necessary — otherwise he wouldn’t have performed them. What definitions are payers using to determine whether a service or [...]
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