top of page
Search

Medical Necessity and Justification

  • Writer: Emily Pasternak
    Emily Pasternak
  • Apr 5, 2021
  • 1 min read

Definition*: Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.


Any and all claims may be called into question and require a copy of medical records for professional review to determine if they meet standards of medical necessity. Recent examples of this may include:


Ex. 1: A patient was delivered in hospital and the delivering OB requests a 2 and 6 week follow-up. The OB bills 59410 for delivery and all postpartum care. The patient then sees a midwife for 2 days, 4 days, 1 week, and 4 week visits. The patient's insurance may request a letter of medical necessity that establishes why it was necessary to see the patient 4 additional times by a secondary provider for routine postpartum care.


While there are many arguments to be made about a higher level of patient care, common postpartum complications, mental health, etc. It is important that your charting and claim coding (ICD-10) reflect that. That way when your care is being evaluated, it is clear in the review that the claims and level of coding was in fact medically necessary in addition to the 2 and 6 weeks OB visits.

 

*https://www.healthcare.gov/glossary/medically-necessary/


 
 
 

Recent Posts

See All

Comentários


Our Billers will not discuss patient balances, bills or benefits over the phone. We can not accept payments on behalf of your provider, payments should be made to your midwife directly. Please email Emily at the email provided below with any questions for further assistance. Thank you!

Contact

e:Emily@gelidabilling.com    fax: 866.422.6682     Business Hours: Monday - Thursday 10am -4pm, Wasilla, Alaska

Formerly My AK Billing LLC

©2017 BY MY AK BILLING. PROUDLY CREATED WITH WIX.COM

bottom of page