Services have been provided, and the physician deemed the procedure/service to be appropriate for the patient. So why aren’t you getting paid? We will tackle that question during this session and provide you with some actionable steps to avoid many of those pesky medical necessity denials.

Many health care organizations that accept Medicare are writing off large sums of unpaid claims due to medical necessity denials. Depending on the volume and types of claims, this can be crippling for your organization. During this session the speaker will review the CMS guidance related to medical necessity; including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), demonstrate the proper way to review coverage determinations and where to find up to date information, provide an overview of the Medicare Coverage Database; including easy ways to locate associated policies, and discuss Advance Beneficiary Notices (ABNs) and the vital role they play in securing means of payment in the event of an anticipated medical necessity denial.