Medical Necessity–Defining and Documenting

Master the New Coding Guidelines to Paint a More Accurate Patient Story

Medical Necessity–Defining and Documenting. Understanding and determining medical necessity can be very complex for you, whether you’re a physician, clinician, coders, or biller. That’s because the definitions of medical necessity will vary depending on who you are. And the fact that the definitions and guidelines keep changing makes it critical for you to stay on top of the changes so that you don’t face payment denials at every turn.

Catch up on the latest medical necessity documentation guidelines in this webinar by coding and reimbursement expert Kim Huey. Find out how the definition of medical necessity has changed; the keys for using the medical necessity modifiers -GA, -GY, -GZ; and the difference between not medically necessary vs. not covered. Huey will show you how to use the Advanced Beneficiary Notification for Medicare and other payers, and provide examples of the right (and wrong) way to document medical necessity.

After attending this session ‘Medical Necessity–Defining and Documenting’, you will be able to confidently access medical necessity guidelines in ICD-10. You will understand the new diagnosis coding guidelines, i.e. how to document and code to paint the accurate picture of the patients you are treating. You will know how to clearly and directly explain medical necessity to physicians, patients, and payers.

Huey’s 35 years of experience in healthcare and Master of Jurisprudence in Health Law helps her to analyze issues and advise clients on new processes and policies they need to implement. So be sure to attend this session and leverage her hands-on experience so that you face fewer medical necessity denials and make more effective appeals in 2019.

Session Highlights

This session will bring you up to speed with:

• Medical necessity documentation guidelines and how they may have changed in ICD-10
• How the definition of medical necessity has changed
• Keys for using the medical necessity modifiers -GA, -GY, -GZ
• The difference between not medically necessary vs. not covered
• How to use the Advanced Beneficiary Notification—for Medicare and other payers
• How to access medical necessity guidelines in ICD-10
• Examples of the right (and wrong) way to document medical necessity
• How to explain medical necessity to physicians, patients, and payers
• How to clearly and directly explain medical necessity to payers through the appeals process

Who Should Attend

• Practice managers
• Coders
• Billers
• Physicians
• Nurse practitioners
• Physician assistants