Definitions of medical necessity vary depending on your role in the revenue cycle—physician coder, biller, or payer. This session will explore and apply the definitions, from helping physicians document appropriately to supporting why they did what they did, assigning the right codes and modifiers, and appealing to receive the payment deserved.

Attendees will learn about:

• The various definitions of medical necessity
• Resources for information on medical necessity
• Strategies for teaching physicians about medical necessity documentation
• Appropriate use of waivers and Advanced Beneficiary Notifications
• Appeals strategies for medical necessity denials
• How to differentiate between not medically necessary and non-covered service denials