Medical Necessity – Defining and Documenting to Support Billing in ICD-10-CM

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

Managing the Change to ICD-10-CM without Jeopardizing Medical Necessity Documentation

Medical Necessity is one of the biggest challenges healthcare professionals face because the Medicare’s definitions of medical necessity varies depending on who you are – physician, coder, biller, payer. In addition, denials related to medical necessity have increased enormously even for legitimate services because of the burdensome appeal claims.  

Join expert speaker Kim Garner-Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO in this session to learn how the definition of medical necessity applies to your medical practice. From helping your physicians document appropriately to support why they did what they did, to assigning the right codes and modifiers, to appealing to receive the payment deserved, Kim will cover it all. Also, learn how to manage the change to ICD-10-CM and maintain medical necessity documentation.

Additionally, you will get links and advice on ABN forms and waivers; tips on appeal language; and how to manage the change to ICD-10-CM without jeopardizing medical necessity documentation.

Session Agenda:

  • Medical Necessity – Definition
  • ICD-10 – Is it okay to use unspecified codes?
  • Finding the Guidelines and Policies
  • Documentation
  • Appealing
  • Teaching Your Providers

Session Highlights:

  • Review of Medical Necessity documentation guidelines and how they may change in ICD-10:
    • Find out how the definition of medical necessity has changed – and will continue to change in ICD-10
    • Is it true claims will not be denied solely based on the specificity of the code, in the first year of ICD-10?
    • ICD-10-CM Specificity: AMA and CMS guidance
    • ICD-10-CM in Payer Policy
    • Accessing medical necessity guidelines in ICD-10
    • Managing the change to ICD-10-CM without jeopardizing medical necessity documentation
  • Keys for using the medical necessity modifiers -GA, -GY, -GZ
  • Understand why correct/appropriate/specific diagnosis coding is critical
  • Get an overview of Medical necessity of an E&M service
  • Balancing Medical Necessity and Meaningful Use
  • Learn the difference between not Medically Necessary and non-Covered services  
  • Examples of the right (and wrong) way to document medical necessity
  • Insights on the use of the Advanced Beneficiary Notification – for Medicare and other payers
  • Modifiers for ABNs and NEMBs
  • How to teach your providers—respectfully
  • Tips on appeal language

Who should attend:

Physicians, coders, billers, office managers, practice managers, revenue cycle managers, administrators

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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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