2024 Gastroenterology Reimbursement and Coding Update | November 2023-The Key to Economic Success: Perfecting Proper Documentation for Medical Necessity

The Key to Economic Success: Perfecting Proper Documentation for Medical Necessity

Video Transcription

Video Summary

The video discusses the importance of medical necessity in healthcare billing and coding. Medical necessity is crucial for services to get preauthorized and paid by insurance companies. The video mentions that payers are increasingly requesting documentation to support medical necessity and may hire outside auditors to review and potentially recoup payments for services they deem unnecessary. The video also provides tips for documenting medical necessity for different procedures, such as endoscopies and E&M services. The video emphasizes the importance of accurately documenting the reason for the encounter, relevant history and exam findings, assessment, plan of care, and diagnoses. It also highlights specific indications for procedures and the need to be specific in documenting symptoms and comorbidities. The video concludes with tips to ensure timely and complete documentation, stay up to date with payer policies, and perform audits to ensure compliance.

Asset Subtitle

Kathleen A. Mueller, RN, CPC, QMC, QGMC, CCS-P, ICD-10 Proficient

Keywords

medical necessity

insurance companies

documentation

auditors

endoscopies

E&M services