Medical Necessity – Defining and Documenting to Support Billing

Event Information
Product Format
Prerecorded Event
Kim Garner-Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, COC
60 minutes
Product Description

Simplifying Medical Necessity—Correct Coding, Compliant Documentation & Effective Appeals

Definitions of medical necessity vary—depending on who you are—physician, coder, biller, or payer. 

This session with expert speaker Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, COC, will explore and apply the definitions to the medical practice. Kim will help your physicians in documenting appropriately to support why they did what they did, assigning the right codes and modifiers, and appealing effectively to receive the payment deserved. 

The session will provide you with the links and advice on ABN forms and waivers and with the tips on appeal language. You will also be able to learn about managing the change to ICD-10-CM without jeopardizing medical necessity documentation.

Session Highlights

  • Medical necessity documentation guidelines and how they may have changed in ICD-10
  • How the definition of medical necessity has changed
  • Keys for using the medical necessity modifiers -GA, -GY, -GZ
  • The difference between not medically necessary vs. not covered
  • Examples of the right (and wrong) way to document medical necessity
  • Use of the advanced beneficiary notification – for Medicare and other payers
  • Accessing medical necessity guidelines in ICD-10

Session Agenda

  • Medical Necessity
    • Definition
  • Claim form language
  • Diagnosis coding
  • ICD-10-CM in payer policy
    • Changes
    • Specificity example
  • Finding the guidelines/policies
  • Evaluation and management
  • Coumadin clinic
  • Clinical descriptors
  • Balancing medical necessity and meaningful use
  • Other EMR issues
  • Documenting medical necessity
  • American college of medical quality (ACMQ) policy on medical review
  • 2016 OIG work plan
  • Auditing concerns
  • Amendments
  • Appeals
  • Advanced beneficiary notification (ABN)
  • Not medically necessary vs. non-covered services

Who Should Attend?

  • Physicians
  • Coders
  • Billers
  • Office managers

Order Below or Call 1-866-458-2965 Today

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About Our Speaker

Kim Garner Huey - Health Care Management Expert

Kim Garner-Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, COC, is an independent coding and reimbursement consultant, providing audit, training and oversight of coding and reimbursement functions for physicians.

Kim completed three years of pre-medical education at the University of Alabama before she decided that she preferred the business side of medicine. She completed a bachelor’s degree in health care management and went on to...   More Info
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