DoctorsManagement simplifies the business of medicine so that healthcare professionals can focus on caring for patients and controlling the future of their business.
Exclusively focused on healthcare, our in-house team of experts help practices of every size and in every specialty increase business performance and patient satisfaction, mitigate compliance risk, and reduce stress for physicians and staff.
Our services include, but are not limited to:
Whether you run a small, independent medical or dental practice, community health system or large integrated healthcare system, our team of in-house consultants and compliance professionals look forward to serving your organization.
This clinical summary is issued in response to the rejection by the internal auditor/reviewer at Palmetto GBA (CMS MAC, Jurisdiction J). The services performed by the facility under a “Medically Necessary” Order complies with both clinical and coding/billing requirements. “Medical Necessity” is the overarching criteria in addition to the individual elements of CPT Code a (Medicare Claims Processing Manual Chapter 12 section 30.6.1). Further, Medical Necessity is defined by Medicare as “health care services or supplies that are needed to diagnose or treat an illness, injury, condition, disease, or its symptoms – and that meet accepted standards of medicine.” (https://www.medicare.org/articles/what-does-medically-necessary-mean/) The services in question relate to ______________________________________, which is both medically appropriate based on generally accepted standards of medical care and a reasonable process by which _____________________ are performed. With regard to this patient… (This is where the provider provides their clinical statement(s)/judgement)