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

Learn about the Changes to the Medical Necessity Documentation Guidelines

Definitions of medical necessity vary depending on who you are – physician, coder, biller, payer. Join this session, where coding and reimbursement expert Kim Huey will explore and apply the definitions to the medical practice. From helping your physicians document appropriately, to support why they did, what they did, from assigning the right codes and modifiers, to helping you receive the payment you deserve.

You will learn how to define and explain the concept of medical necessity, how to access medical necessity guidelines, the importance of Advanced Beneficiary Notifications and waivers, and correct use of modifiers to ensure that patients can be billed as appropriate. You will have fewer medical necessity denials, and more effective appeals.

Session Highlights

This session will cover:

  • 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.
  • 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.
  • Accessing medical necessity guidelines in ICD-10.

Session Agenda

  • Diagnosis coding
  • ICD-10-CM in payer policy
  • ICD-10-M changes
  • Evaluation and management
  • Medical necessity
  • Balancing medical necessity  and meaningful use
  • Certificate of medical necessity
  • How to document medical necessity
  • Medical necessity – auditing concerns
  • Modifiers for ABNs
  • Home health care change of care notice
  • Not medically necessary vs. non-covered services

Who Should Attend

  • Physicians
  • Coders
  • Billers
  • Billing managers
  • Coding managers
  • Administrators

Order Below or Call 1-844-384-4744 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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