Medical necessity under OPPS: a look at the challenges.
The outpatient prospective payment system (OPPS) has dramatically changed claims processing by introducing an automated system. Medical necessity validation has also been automated as a result, leaving hospitals with increased rejections. This article explores how OPPS impacts tile medical necessity process.
Carter
Darren
D
Provistas, New York, NY, USA. dcarter@provistas.com
D000553:Ambulatory Care; D006801:Humans; D007345:Insurance Claim Review / Q000458:organization & administration*; D020380:Needs Assessment; D011445:Prospective Payment System; D014481:United States