Session: Medical Necessity: It's Not Just for Nurses Anymore!
Presenter: Patt King, CHDS, CHDP, AHDI-F
Session Description:
A new role for healthcare documentation specialists (HDSs) involves using our intimate knowledge of healthcare documentation, surgical procedures, anatomy, medical/surgical conditions, etc., as well as clinician-created documentation auditing, to determine whether a surgical case or procedure meets the medically necessity requirements of the patient’s specific insurance payor. This role requires additional extensive and intensive learning, including insurance payor policies/guidelines and common procedural terminology (CPT) codes, as well as direct communication with physicians. The purpose is to ascertain that appropriate documentation is completed by the provider prior to scheduled procedures to support financial clearance and payment to the hospital.
Learning objectives
1. Learn how this proof-of-concept role began at Tucson Medical Center in Tucson, AZ.
2. Learn about “medical necessity”—what it is and why it is so important for patients, physicians, and facilities.
3. Learn why the HDS is the perfect candidate to fill this role.
4. Learn about a typical day for a medical necessity analyst (MNA).