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Practice Management Alert

Reader Question:
Understand ‘Medical Necessity’

Question: My practice has had a couple of claims denied. The payers said the services rendered by our practice’s physician were not “medically necessary.” I’m sure the physician thought the services were medically necessary — otherwise he wouldn’t have ordered or performed them. What definitions are payers working off of? Washington, D.C. Subscriber Answer: According to the American Medical Association’s [...]