If you have a bacterial infection, you need to take antibiotics. If health care providers need to determine that you have a broken bone, you’ll need to have an X-ray. Those are some examples of ...

Medicare limits coverage to treatments, services, and supplies deemed medically necessary. If Medicare does not consider a service medically necessary, it will typically not cover it. Medicare covers ...

As recovery audit contractors set their sites on medical necessity of inpatient stays, hospitals enter a hazy area of compliance. RAC consultants say Medicare definitions of what constitutes inpatient ...

Two recent publications issued by CMS clearly indicate that the organization is tightening its requirements for the documentation required to support medical necessity and mandated signatures on ...

CMS does not expect its Medicare recovery audit contractors to conduct complex reviews for medical necessity of hospital services until 2010, according to a news release from the American Hospital ...

Clinical and administrative staff at many organizations are struggling with the issue of what "medically necessary" really means - even those who have reviewed the Medicare Benefit Policy Manual (MBPM ...

Medicare uses the 2-midnight rule to determine whether to bill a hospital stay under Part A or Part B. This rule has implications for both costs and coverage. Original Medicare consists of Part A ...

Q: What’s new with wound care documentation and CMS guidelines? A: The Center for Medicare & Medicaid Services recently issued modifications in Local Coverage Determinants that can potentially affect ...