Question

_______ is the established evidence of the appropriateness of resource use in the medical treatment of a patient based on the patient's diagnosis and standards of care.

a) Treatment plan
b) Medical abstraction
c) Mutual agreement
d) Medical necessity

Answer 1

Medical necessity is the evidence of appropriate resource use in patient treatment, based on diagnosis and care standards, crucial in clinical and insurance contexts.

Step-by-step explanation:

The correct option : d

Medical necessity is the term used to describe the established evidence of the appropriateness of resource use in the medical treatment of a patient. This is based on the patient's diagnosis and the accepted standards of care within the medical community. It involves a range of considerations, including the evaluation of the type of care, its timing, and the setting in which it is provided, all to ensure that the treatment provided is necessary and appropriate for the patient's condition.

Medical necessity is a fundamental concept in both clinical decision-making and in the context of health insurance, as insurers typically require treatments to be medically necessary in order to cover the costs. Therefore, it is a crucial aspect of health care that impacts both patient care and healthcare finances. Medical necessity ensures that healthcare resources are used efficiently and effectively, focusing on providing the appropriate level of care to patients.