Question

Medical necessity is defined by which three factors?

Answer 1

Medical necessity is defined by three factors: diagnosis or condition, evidence-based, and cost-effectiveness.

Step-by-step explanation:

Medical necessity is defined by three factors:

1. Diagnosis or condition: The treatment or service must be necessary to treat a specific diagnosis or medical condition. For example, a patient with a broken bone may require a cast or surgery to heal properly.
2. Evidence-based: The treatment or service must be supported by scientific evidence showing its effectiveness. This ensures that medical interventions are proven to improve patient outcomes. For instance, a medication prescribed for a certain condition should have evidence demonstrating its efficacy.
3. Cost-effectiveness: The treatment or service must be cost-effective compared to alternative options. Healthcare providers consider the benefits and risks as well as the financial impact on both the patient and the healthcare system.