Published by: Administrator
Medical necessity is a term healthcare providers often encounter when it comes to the approval or denial of claims by insurance payers. Yet, despite its ubiquitous use, the concept of medical necessity remains somewhat nebulous and open to interpretation. Understanding how payers define and determine medical necessity is critical for healthcare providers to ensure that their services are reimbursed. This article will take a deep dive into payer perspectives on medical necessity, how it influences claim approvals and denials, and what providers can do to meet payer requirements while delivering quality care to patients.
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