Medicare's Documentation Guidelines for Establishing Medical Necessity

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

Ensuring accurate documentation to establish medical necessity is critical, specially when the definition of medical necessity vary depending on who you are - physician, biller, payer, coder or someone else in the Medicare Reimbursement function. You need your physicians and staff to document appropriately to ensure that you have everything you need for an Optimized Reimbursement Cycle. You have to be updated through a number of different changes - right from filing appeals for accurate reimbursement, getting familiar with the guidelines on the right appeal language, links and advice on the new ABN forms and much more.

Topics covered:

  • Medical Necessity documentation guidelines .
  • How the definition of medical necessity has changed - and will continue to change.
  • Not medically necessary vs. not covered - What's the difference?
  • Examples of the right (and wrong) way to document medical necessity.
  • Use of the Advanced Beneficiary Notification - for Medicare and other payers.
  • Finding the Guidelines/Policies
  • Claim Form Language
  • Medical necessity for E&M
  • Clinical Descriptors
  • Balancing Medical Necessity and Meaningful Use
  • What are the auditors looking for - Authentication, Contradictions, Wording or grammatical errors, Medically impausible documentation
  • How to Document & Certificate of Medical Necessity
  • Appeal Testimony & How to Teach Your Providers
  • Advanced Beneficiary Notification & ABN Rules
  • Keys for using the medical necessity modifiers -GA, -GY, -GZ
  • And much more...

Who should attend? Compliance personnel, HIPAA Officer, Chief Information Officer, Health Information Manager, Medical Office Manager, CFO, CEO, COO, Physicians, coders, billers, office managers

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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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