Establishing CMS Medical Necessity- Documentation & Billing Requirements To Avoid Denials

Webinar Description, Agenda & Trainer Profile :

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, a healthcare plans idea of what is medically necessary does not match the healthcare providers 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 office or hospital.

The following agenda will be discussed in detail during this session :

• Documentation requirements that supports medical necessity while getting reimbursed
• Demonstration and Examples of establishing medical necessity for E/M services
• Updated guidelines on issuing Advanced Beneficiary Notices
• 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 

Ask your questions & get expert advice directly from the speaker during the informative Q/A session at the end of the webinar session.

About The Trainer : Mrs. Jacqueline Thelian is a Healthcare Consultant, Certified Professional Coder & Auditor, Subject Matter Expert and sought after educator and Author with over twenty years’ experience in medical coding and business management. Her extensive experience includes physician practice management, coding/billing compliance and reimbursement issues and she has taught extensively in Academic Medical Centers, The Chubb Institute, Hospitals, private physician practices and has conducted a variety of seminars for numerous Medical Societies. She is also a AAPC Certified PMCC instructor for the PMCC (Professional Medical Coding Curriculum) Coding Certification Prep Course, and a Certified ICD-10 Expert Trainer. Her articles on clinical coding issues have been published in many popular healthcare publications.