Medical Necessity Basics (Medicaid)
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
Advance Preparation: None
Program level: Basic
Delivery Method: Self-study
CPE Field of Study: Specialized Knowledge
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