Medical Fraud or Medical Necessity: Documenting Your Story

Theresa DeAngelis, Kirti V. Reddy
From: May 06, 2022 - To: Dec 31, 2022
Recorded Webinar


Gain an understanding of the medical necessity and the importance of correct documentation.

The difference between the government making a determination of medical fraud as opposed to medical necessity lies in your documentation. Physicians, hospitals, labs, long-term care providers, and all other medical providers must properly document that their services were medically necessary. This course will inform providers, compliance professionals, and billers of the meaning and interpretation of the term medical necessity. The course will also provide guidance for properly documenting the procedures and services performed. To better understand the impact of proper documentation of medical necessity, this material will focus on recent government prosecutions and settlements, particularly in areas of increased government focus, such as telehealth services. Gain practical tips and considerations for documenting medical necessity.

Learning Objectives:-

  • You will be able to define the term medical necessity.
  • You will be able to discuss appropriately documenting medical necessity.
  • You will be able to review lessons learned from recent government prosecutions.
  • You will be able to review practical considerations.


The Definition and Application of the Term Medical Necessity

  • Medical Necessity as Defined by CMS
  • Medical Necessity as Defined by States
  • Medical Necessity as Defined by the Courts

Appropriately Documenting Medical Necessity

  • Document Type, Frequency, Extent, and Duration
  • Standards of Practice
  • Evaluation and Diagnosis Codes

Lessons Learned From Recent Government Prosecutions

  • Overview of Recent Cases
  • Potential Defenses

Practical Considerations

  • Policies
  • Internal Audits
  • Results: Effective Communication, Correct and Timely Reimbursement, and Patient Safety

Who Should Attend:-

This live webinar is designed for medical records directors, health information directors, coders, business managers, office managers, nurses, hospital administrators, billing managers, social workers, counselors, the release of records professionals, and compliance managers.

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