Determining CMS Medical Necessity In 2021- Documentation & Billing Requirements To Avoid Denials

All providers should ensure they are on the same page with their healthcare plans and payers when it comes to documentation and compliance guidelines required to support medical necessity. Failure to prove medical necessity usually results in hefty fines and penalties, along with legal repercussions in some cases. Demonstrating medical necessity for the services provided to beneficiaries on the front end can reduce the man-hours and frustration on the back end surrounding denied services. Occasionally, healthcare plans idea of what is medically necessary does not match the healthcare provider's definition. Failure to clearly document and support medical necessity for services, in accordance with payer policies, can lead to loss of revenue and may even financially cripple a physician's office or hospital.??

Agenda:-

• 2021 Documentation requirements that support medical necessity while getting reimbursed
• Demonstration and Examples of establishing medical necessity for E/M services
• Must follow compliance guidelines in 2021
• Updated guidelines on issuing Advanced Beneficiary Notices in 2021
• Responding to medical necessity denials – Protocols and timelines involved
• Understanding the role of modifiers in medical necessity
• Importance of providing Certificates of Medical Necessity
• Outlining the roles of pre and post-billing medical necessity reviews
• Guidelines and importance of follow-up on a medical necessity denial
• Facilitating Provider Education – The right way to go
• Examples of the right and wrong way to document medical necessity
• Rules around medical necessity modifiers -GA, -GY, -GZ
• FAQs & Resources