October 2012

October 2012

"Why do I get medical necessity denials?"

Medical necessity is what drives the payment of any claim submitted to an insurance carrier. Without proper documentation, your claims are dismissed. It's mission critical to make sure that you can prove that what you did was justified and produced a measurable difference.

Necessity is defined as a condition or quality of being necessary; a pressing or urgent need; the condition of being essential. As for medical necessity, you must have a valid expectation, at the time care is rendered to a patient, that improvement will occur. And that later, it has.

What must your documentation include to prove medical necessity?

  • Patient consultation and history data
  • Physical examination findings, tests and measurements
  • Subjective complaints mentioned by the patient
  • Diagnosis/diagnoses
  • Treatment plan(s)
  • Achievable functional goals as the result of your care

Thankfully, properly using the integrated paperwork system from Chiropractic Paperwork makes it easy to satisfy the medical necessity requirements of virtually any carrier.

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