Medical Necessity Basics (Medi-Cal)

Medical necessity is a concept used by healthcare providers and payers to mean “services that are required and appropriate for a patient’s condition.”

  • Define medical necessity and identify its importance
  • Differentiate between medical necessity for Medicare and private payers
  • Identify best practices for determining medical necessity
  • Name implications of medical necessity determination

Additional Information

Advance Preparation: None

Prerequisites: None

Program level: Basic

Delivery Method: Self-study

CPE Field of Study: Specialized Knowledge


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