Day 4: Medical Necessity: It's Not Just for Nurses Anymore!
- Education:
- All Education | Member Benefits
- CEC Category:
- Professional Development
- Duration:
- 1 Hour 19 Minutes
- Format:
- Audio and Video
Tags: HDIVC25
Description
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).
Handouts
| Medical Necessity (2.43 MB) | Available after Purchase | ||
Speaker
Patricia A King, CHDS, CHDP, AHDI-F Related Seminars and Products
Manager, Medical Necessity – Pre-Services
Tucson Medical Center
Patt King, CHDS, CHDP, AHDI-F, currently serves as AHDI’s Immediate Past President for the 2024–2025 term, concluding her second tenure as President of the Association. From 2013 to 2024, she was a Health Information Management (HIM) manager at Tucson Medical Center (TMC) in Tucson, Arizona, where she led a team of healthcare documentation specialists. In January 2024, she transitioned to a new role as Manager of the Proof-of-Concept Department for Medical Necessity – Pre-Services within TMC’s Revenue Cycle. Her former team of HDSs also transitioned and now serve as medical necessity analysts. In addition to her leadership roles on AHDI’s Executive Committee over the years, Patt continues to co-chair the Best Practices Task Force, which is currently focused on updating AHDI’s Compensation Best Practices Toolkit. She remains committed to supporting AHDI through ongoing volunteer work on future initiatives.