Question

Summarize the importance of medical necessity and how it relates to medical documentation, coding, and reimbursement? Analyze the process of reviewing medical documentation and note the importance of quality control.

Answer 1

Step-by-step explanation:

For a service to be considered medically necessary, it must be reasonable and necessary to diagnosis or treat a patient’s medical condition. When submitting claims for payment, it is the diagnosis codes reported with the service that tells the payer “why” a service was performed. The diagnosis reported can be the determining factor in supporting or not supporting the medical necessity of the procedure.