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

Medical Necessity – What You Need to Know for Optimized Reimbursements

Accurate documentation to establish medical necessity is critical, especially when the definition of medical necessity vary depending on who you are – physician, biller, payer, coder or someone else in the Medicare Reimbursement function. There is a difference between clinical medical necessity and billing medical necessity. Just because YOU think it’s medically necessary doesn’t mean it’s going to be.

Join expert speaker Kim Huey, MJ, CPC, CCS-P, PCS, CPCO in this informative session to demystify and apply the definitions of medical necessity to your practice. Kim will shed light on the entire picture—from helping your physicians document appropriately to support why they did, what they did, assigning the right codes and modifiers, to appealing, to receive the payment deserved.

Additionally, she will provide links and advice on ABN forms and waivers, and also provide tips on appeal language.

Areas covered in the session:

  • Medical Necessity documentation guideline—the nuts and bolts
  • How the definition of medical necessity has changed – and will continue to change in future
  • Why correct and appropriate diagnosis coding is critical
  • Will ICD-10 help?
  • Keys for using the medical necessity modifiers -GA, -GY, -GZ
  • Not medically necessary vs. not covered – what’s the difference
  • Discussion on medical necessity of an E&M service
  • Medical Necessity and Medical Decision-Making not the same thing
  • Balancing Medical Necessity and Meaningful Use
  • Medical necessity and the concerns with electronic records and overcoding
  • Examples of the right (and wrong) way to document medical necessity
  • Use of the ABNs – for Medicare and other payers
  • Insights on Modifiers for ABNs and NEMBs
  • Discussion on ABN rules
  • What are auditors looking for?
  • Medical Necessity of services performed – or services billed? Who can judge the medical necessity of a service?

Who should attend

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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