Legal basis and interpretations of medical necessity.
This article examines the legal issues surrounding medical necessity in Medicare reimbursement. The author reviews how the Health Care Financing Administration has defined medical necessity for laboratory testing and the role of the laboratory and the laboratory manager in ensuring medical necessity.
Kazon
P M
PM
O'Connor & Harman, Washington, DC, USA.
D014487:Centers for Medicare and Medicaid Services, U.S.; D019411:Clinical Laboratory Techniques / Q000191:economics*; D003284:Contract Services / Q000191:economics; D003955:Diagnostic Tests, Routine / Q000191:economics*; D019983:Guideline Adherence; D017408:Guidelines as Topic; D019458:Insurance Coverage / Q000331:legislation & jurisprudence; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000331:legislation & jurisprudence*; D006278:Medicare / Q000191:economics / Q000331:legislation & jurisprudence*; D014481:United States; D019564:Unnecessary Procedures / Q000191:economics; D014600:Utilization Review