In billing and coding, what does the term "medical necessity" generally mean?
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Medical Office Assistant · Medical Economics, Billing, and Coding
Medical Necessity in Coding and Billing
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5 questions here, of 85 in this lesson’s practice set. Answers stay hidden until you check.
Which phrase best captures the Medicare/CMS standard used to decide whether a service is medically necessary?
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A service provided primarily for the convenience of the patient or the provider is generally...
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Which of the following is a key element of medical necessity?
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Medical necessity generally requires services to be furnished at the most appropriate level of care, which means...
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Study tools & related lessonsYou’ll learn to · Related
You’ll learn to
- Define medical necessity and explain the elements of services that are reasonable and necessary for diagnosis or treatment.
- Relate clinical documentation, including diagnosis-to-procedure linkage, to establishing medical necessity.
- Recognize coverage determination concepts, including National and Local Coverage Determinations, prior authorization, and Advance Beneficiary Notices.
- Apply scope-of-practice boundaries by gathering and routing information and escalating medical necessity determinations to clinicians and billing professionals.
- Identify documentation and coding practices that prevent medical necessity denials and avoid fraud and abuse.
Sources & references
- Centers for Medicare & Medicaid Services — CMS.gov
- American Health Information Management Association — AHIMA - Health Information and Coding
- AAPC — Medical Coding and Billing
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