Podcast: Tackling Medical Necessity

August 9, 2012
Sara Michael

Stacie Buck, of RadRx, details the issues around medical necessity and gives guidance for developing a process for reducing denials.

[[{"type":"media","view_mode":"media_crop","fid":"11881","attributes":{"alt":"","class":"media-image media-image-left","id":"media_crop_3550233481514","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"204","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"margin: 5px; float: left;","title":" ","typeof":"foaf:Image"}}]]Reimbursement for radiology services often relies on proof of the medical necessity of the exam, which means radiologists have to document that well to get paid. To do so, radiologists must work with their referring physicians to get the right information – just one of a few challenges with regard to medical necessity. Another hurdle necessary for payment? Obtaining advanced beneficiary notices from patients.

In this podcast, Stacie Buck, RHIA, CCS-P, RCC, CIC, president and senior consultant for RadRx, which provides coding consulting and support services for radiology providers, details the issues around medical necessity.

Buck addresses:

• Why showing medical necessity for an exam is critical for reimbursement.

• The role of the advanced beneficiary notice as a protection for provider and patient, and why many radiology groups don’t always get that paper signed.

• Developing an effective process for reducing denials.

• How to work with referring physicians to ensure the radiology practice obtains the proper information to document medical necessity.