Medical necessity is a term that holds different meanings for different parties in the healthcare industry. For healthcare providers, it is about the patient's clinical needs, while for insurance payers, it revolves around coverage policies and guidelines.
Medicare defines medical necessity as:
“No payment may be made under part A or part B for any expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member … or for the prevention of illness, and in the case of hospice care, which are not reasonable and necessary for the palliation or management of terminal illness.”
It is essential to understand these definitions and how they apply to each patient's unique circumstances. Join us for an in-depth webinar by industry expert speaker Toni Elhoms, CCS, CRC, CPC, AHIMA-Approved ICD10-CM/PCS Trainer, where she will explore payer definitions, guidelines, and policies, including Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs).
Webinar Objectives
This session aims to bridge the gap between healthcare providers' and payers' perspectives on medical necessity. Attendees will:
Webinar Agenda
Webinar Highlights
Who Should Attend
Toni Elhoms, CCS, CRC, CPC, AHIMA-Approved ICD10-CM/PCS Trainer is a nationally known speaker and recognized subject matter expert on medical coding, reimbursement, and revenue cycle management. She is the Founder and CEO of Alpha Coding Experts, LLC. She holds multiple credentials with the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). With over a decade of industry experience, she has led and supported hospital systems, universities, physician practices, payers, government agencies, and other entities on coding, billing, and compliance initiatives. She is a frequent contributor to various…
Read MoreDate | Conferences | Duration | Price | |
---|---|---|---|---|
Dec 03, 2024 | 2025 OIG Audit Targets | 60 Mins | $199.00 | |
Nov 07, 2024 | 2025 CPT Updates for Pain Management | 60 Mins | $199.00 | |
Oct 01, 2024 | Credentialing in 2024, Tips For Success | 60 Mins | $199.00 | |
Sep 26, 2024 | Medicare enrollment revalidation form filling, fees, documentation & pitfalls - 2024 Updates | 60 Mins | $199.00 | |
Sep 12, 2024 | Deconstructing Medical Necessity from a Payer Perspective | 60 Mins | $199.00 | |
Aug 29, 2024 | Dissecting the Operative Report in 2024 | 60 Mins | $199.00 | |
Aug 27, 2024 | Mastering the Charge Master Validation Process | 60 Mins | $199.00 |