In health care billing and coding, what does the term “medical necessity” mean?
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Medical Office Assistant · Medical Economics, Billing, and Coding
Medical Necessity, Documentation, and Querying
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5 questions here, of 89 in this lesson’s practice set. Answers stay hidden until you check.
Which party generally decides whether a specific service meets the definition of medical necessity?
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Which statement best describes the relationship between medical necessity and payment for a service?
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What is the primary purpose of documenting medical necessity in the patient's record?
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A service can be covered by a health plan but still be denied for a particular patient. What is the most likely reason?
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Study tools & related lessonsYou’ll learn to · Related
You’ll learn to
- Explain medical necessity and how payers apply it to coverage and payment.
- Relate documentation to code assignment, including specificity, sequencing, and supporting source documents.
- Describe compliant querying of clinicians through proper channels when documentation is unclear, conflicting, or incomplete.
- Recognize the assistant's support role and scope-of-practice boundaries in documentation and querying.
- Apply the principle of never assuming, and escalate or query rather than guessing or altering records.
Sources & references
- Centers for Medicare & Medicaid Services — ICD-10
- American Health Information Management Association — AHIMA - Health Information and Coding
- AAPC — Medical Coding and Billing
This lesson was adapted from the open educational references above; their licenses and attributions are preserved. See Copyright & Licensing.
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