Question

What are some of the common reason why Medicare may deny a procedure and service

Answer 1

Medicare may deny a procedure or service for reasons such as lack of medical necessity, lack of coverage, or incorrect coding/documentation.

Step-by-step explanation:

Medicare may deny a procedure or service for several reasons:

1. Lack of medical necessity: Medicare may determine that a procedure or service is not medically necessary for the patient's condition. In other words, it may not be essential for the patient's health or well-being.
2. Lack of coverage: Medicare has specific guidelines on what procedures and services it covers. If a procedure or service is not included in the list of covered benefits, Medicare may deny it.
3. Incorrect coding or documentation: If the medical codes or the supporting documentation for a procedure or service are not accurate or complete, Medicare may deny it.