The Changing Definition of Medical Necessity

Medicare, Medicaid & Private Payor Updates /

(July 16, 2014):The term “medical necessity” has varying definitions depending on who is using it. Providers, physicians, courts, private insurers, state governments, and the federal government all have their own interpretation of what constitutes medical necessity. This changing definition of medical necessity can be problematic when a provider’s claims are audited by a Zone Program […]

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