Compliance Issues and Medical Necessity
Mark Bondurant, CPO
Description
Collection
Title:
Compliance Issues and Medical Necessity
Creator:
Mark Bondurant, CPO
Text:
Dear OandP List
In development of our Medicare Compliance program (pursuant to 1999 OIG
report recommendations), we have had good success in designing and
implementing our program in all but one aspect, the issue of Medical
Necessity.
(It must be stated here that formulation of our compliance program was
critically dependent on the excellent work done by Kathy Dodson, Mike
O'Donnell, and others in AOPA, and needs to be recognized as the definitive
body of work on the subject. My heartfelt thanks to all who participated in
this project!)
The grey area in question is that of Medical Necessity. As this is largely
subjective, one practitioner's opinion compared to another, I feel there is
no aspect of Medical Necessity that can not be argued. Because of this, it
is quite difficult to establish how Medical Necessity is to be defined for
Medicare purposes. I am seeking input from the list members for this, and
seeking any ideas of proper ways to document and/or define Medical Necessity
for Medicare claims. If you have a method of documenting Medical Necessity
for your patients that works well for you, please respond. All responses
will be compiled and reposted to the list when complete.
Thank you for your input.
Mark Bondurant, CPO
In development of our Medicare Compliance program (pursuant to 1999 OIG
report recommendations), we have had good success in designing and
implementing our program in all but one aspect, the issue of Medical
Necessity.
(It must be stated here that formulation of our compliance program was
critically dependent on the excellent work done by Kathy Dodson, Mike
O'Donnell, and others in AOPA, and needs to be recognized as the definitive
body of work on the subject. My heartfelt thanks to all who participated in
this project!)
The grey area in question is that of Medical Necessity. As this is largely
subjective, one practitioner's opinion compared to another, I feel there is
no aspect of Medical Necessity that can not be argued. Because of this, it
is quite difficult to establish how Medical Necessity is to be defined for
Medicare purposes. I am seeking input from the list members for this, and
seeking any ideas of proper ways to document and/or define Medical Necessity
for Medicare claims. If you have a method of documenting Medical Necessity
for your patients that works well for you, please respond. All responses
will be compiled and reposted to the list when complete.
Thank you for your input.
Mark Bondurant, CPO
Citation
Mark Bondurant, CPO, “Compliance Issues and Medical Necessity,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/215873.
