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Primary Care Coding Alert

Reader Question:
Know These Definitions for 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 from? Maryland Subscriber Answer:  According to the American Medical Association’s (AMA’s) 2011 report to [...]