Meeting the medical necessity requirement.
Establishing the medical necessity of a procedure is increasingly important--and complex--because medical techniques are evolving faster each year. Add the rising number, cost, and complexity of innovative and experimental medical treatments to the easy accessibility of medical information now available to consumers and you have all the criteria for confusing medical fact with medical potential. It's difficult for specialists and subspecialist physicians to keep up with their field--and impossible for case managers.
Freedman
Skip
S
AllMed Healthcare Management, Portland, OR, USA.
D019882:Blepharoplasty; D019090:Case Management / Q000458:organization & administration*; D003363:Cost Control; D003659:Decision Making, Organizational; D004608:Eligibility Determination / Q000458:organization & administration*; D019317:Evidence-Based Medicine; D006301:Health Services Needs and Demand; D006801:Humans; D007345:Insurance Claim Review; D019458:Insurance Coverage; D020380:Needs Assessment; D009369:Neoplasms / Q000628:therapy; D009730:Nursing Assessment; D010344:Patient Advocacy; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D019564:Unnecessary Procedures; D014648:Varicose Veins / Q000628:therapy