What documentation should be submitted for review when medical necessity may be questioned?
Services for which medical necessity may be questioned should be documented with additional clinical evidence. This evidence may include office records, physician notes or diagnoses characterizing the patient’s physical status as being of such an acute or severe nature that more frequent services are indicated. In the case of mycotic nails, the medical record should contain a description of the nails that requires debridement. In the absence of a systemic condition in these patients, documentation of the marked limitation of ambulation or in the case of non-ambulatory patients, that the condition is likely to result in significant medical complications in the absence of such treatment.
Related Questions
- Will time requirements for documentation submitted to the Institutional Review Board (IRB)/ Ethics Committee (EC) also apply for consents that must be translated into other languages as well?
- What documentation should be submitted for review when medical necessity may be questioned?
- When Does Medical Necessity Review Organization (MNRO) Apply?
