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Medical Necessity Concept in Practice Medical Necessity: Who Cares? What payers? What about accreditors? Even for rehab option? What about recovery programs and services?
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As per Cigna’s definition Medical Necessity means health care services that a physician, exercising prudent clinical judgment, would provide to a patient. For the purpose of evaluating, diagnosing, or treating an illness, injury, disease, or its symptoms In accordance with the generally accepted standards of medical practice
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Failure to prove medical necessity for pain management services leads to claim denials. We shared basic Medicare guidelines for accurately documenting medical necessity for pain management services.
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