SlideShare a Scribd company logo
1 of 2
Download to read offline
Medical Necessity - Primer on Key Legal Principles and
Operational Compliance
This webinar on the legal principles of 'Medical Necessity' will cover the compliance background
and provide practical advice on how healthcare providers can understand and apply ‘medical
necessity’ principles.
Why Should You Attend:
'Medical Necessity' principles are a fundamental component of health care delivery and
payment for both government and private health plans. Moreover, both individual and
organizational providers face undesirable consequences if they do not learn and follow these
principles. The consequences range from mere ‘warning notices’ to possible criminal charges.
The objective of this 90-minute webinar is to provide a solid frame of reference for those who
must deal with ‘medical necessity’ issues as part of their core job responsibilities.
The session designed to provide historical and legal context that will help attendees understand
the social and payment policies related to medical necessity determinations, as applied in our
health care industry. The webinar also will analyze specific statutory and regulatory authorities
that are the sources of most interpretive differences of what is or is not a ‘medically necessary’
item or service. Several, specific examples of clinical services will be discussed.
Areas Covered in the Webinar:
Legal Overview
Examples of how payment reforms relate to ‘medical necessity’
Enforcement techniques and related sanctions
Suggestions for reducing risks of denials, repayment obligations and other legal
penalties
Methods to educate and train providers and support personnel on ‘medical necessity’
Who will benefit:
The following personnel in medical offices, hospitals, medical centers and clinics will benefit:
Clinical Service Administrators
Process Improvement Teams, especially Revenue Cycle and Patient Accounts
Clinicians
Compliance Professionals
Financial Officers
Physicians
For more details visit us at:
http://www.complianceonline.com/ecommerce/control/trainin
gFocus/~product_id=703145

More Related Content

What's hot

Privacy and confidentiality
Privacy and confidentialityPrivacy and confidentiality
Privacy and confidentiality
scarollo
 
CME Coalition Sunshine Grassroots Presentation 1-11-12
CME Coalition Sunshine Grassroots Presentation 1-11-12CME Coalition Sunshine Grassroots Presentation 1-11-12
CME Coalition Sunshine Grassroots Presentation 1-11-12
cmecoalition
 

What's hot (9)

HIPAA Training: Preventing Employees from Violating HIPAA
HIPAA Training: Preventing Employees from Violating HIPAAHIPAA Training: Preventing Employees from Violating HIPAA
HIPAA Training: Preventing Employees from Violating HIPAA
 
Economic Credentialing - Abuse of Peer Review?
Economic Credentialing - Abuse of Peer Review?Economic Credentialing - Abuse of Peer Review?
Economic Credentialing - Abuse of Peer Review?
 
Hcs 430 hcs430
Hcs 430 hcs430Hcs 430 hcs430
Hcs 430 hcs430
 
Privacy and confidentiality
Privacy and confidentialityPrivacy and confidentiality
Privacy and confidentiality
 
CME Coalition Sunshine Grassroots Presentation 1-11-12
CME Coalition Sunshine Grassroots Presentation 1-11-12CME Coalition Sunshine Grassroots Presentation 1-11-12
CME Coalition Sunshine Grassroots Presentation 1-11-12
 
P.c.james
 P.c.james P.c.james
P.c.james
 
Reno, NV, Lawyer Kelly Testolin - Accountable Care Organizations
Reno, NV, Lawyer Kelly Testolin - Accountable Care OrganizationsReno, NV, Lawyer Kelly Testolin - Accountable Care Organizations
Reno, NV, Lawyer Kelly Testolin - Accountable Care Organizations
 
THCS Workforce HIPAA Training
THCS Workforce HIPAA TrainingTHCS Workforce HIPAA Training
THCS Workforce HIPAA Training
 
The Affordable Care Act- Two Years Later
The Affordable Care Act- Two Years LaterThe Affordable Care Act- Two Years Later
The Affordable Care Act- Two Years Later
 

Similar to Medical necessity

Understand Legal Needs in Healthcare: Use The Medical–Legal Partnership Toolkit
Understand Legal Needs in Healthcare: Use The Medical–Legal Partnership ToolkitUnderstand Legal Needs in Healthcare: Use The Medical–Legal Partnership Toolkit
Understand Legal Needs in Healthcare: Use The Medical–Legal Partnership Toolkit
Practical Playbook
 
The Medical-Legal Partnership Toolkit
The Medical-Legal Partnership ToolkitThe Medical-Legal Partnership Toolkit
The Medical-Legal Partnership Toolkit
Practical Playbook
 
4 hours agoAmy MillerRE Discussion - Week 7CollapseNU.docx
4 hours agoAmy MillerRE Discussion - Week 7CollapseNU.docx4 hours agoAmy MillerRE Discussion - Week 7CollapseNU.docx
4 hours agoAmy MillerRE Discussion - Week 7CollapseNU.docx
rhetttrevannion
 
Major Laws Affecting Healthcare.docx
Major Laws Affecting Healthcare.docxMajor Laws Affecting Healthcare.docx
Major Laws Affecting Healthcare.docx
4934bk
 
HCAD 650 group 2 project oral presentation for the role of a compliance offi...
HCAD 650  group 2 project oral presentation for the role of a compliance offi...HCAD 650  group 2 project oral presentation for the role of a compliance offi...
HCAD 650 group 2 project oral presentation for the role of a compliance offi...
Modupe Sarratt
 
In Module One, our first step is to direct our focus on what healt
In Module One, our first step is to direct our focus on what healtIn Module One, our first step is to direct our focus on what healt
In Module One, our first step is to direct our focus on what healt
rafbolet0
 
Legal Aspects of OH Article
Legal Aspects of OH ArticleLegal Aspects of OH Article
Legal Aspects of OH Article
lmk1970
 
Healthcare - Customer-Centric Healthcare Best Practices for CIO and CISOs
Healthcare - Customer-Centric Healthcare Best Practices for CIO and CISOsHealthcare - Customer-Centric Healthcare Best Practices for CIO and CISOs
Healthcare - Customer-Centric Healthcare Best Practices for CIO and CISOs
Nicholas Christiano Jr.
 

Similar to Medical necessity (20)

Understand Legal Needs in Healthcare: Use The Medical–Legal Partnership Toolkit
Understand Legal Needs in Healthcare: Use The Medical–Legal Partnership ToolkitUnderstand Legal Needs in Healthcare: Use The Medical–Legal Partnership Toolkit
Understand Legal Needs in Healthcare: Use The Medical–Legal Partnership Toolkit
 
The Medical-Legal Partnership Toolkit
The Medical-Legal Partnership ToolkitThe Medical-Legal Partnership Toolkit
The Medical-Legal Partnership Toolkit
 
4 hours agoAmy MillerRE Discussion - Week 7CollapseNU.docx
4 hours agoAmy MillerRE Discussion - Week 7CollapseNU.docx4 hours agoAmy MillerRE Discussion - Week 7CollapseNU.docx
4 hours agoAmy MillerRE Discussion - Week 7CollapseNU.docx
 
Align your compliance efforts with the 2014 oig strategy
Align your compliance efforts with the 2014 oig strategyAlign your compliance efforts with the 2014 oig strategy
Align your compliance efforts with the 2014 oig strategy
 
Cblt power point
Cblt power pointCblt power point
Cblt power point
 
Major Laws Affecting Healthcare.docx
Major Laws Affecting Healthcare.docxMajor Laws Affecting Healthcare.docx
Major Laws Affecting Healthcare.docx
 
Current Procedural Terminology
Current Procedural TerminologyCurrent Procedural Terminology
Current Procedural Terminology
 
HCAD 650 group 2 project oral presentation for the role of a compliance offi...
HCAD 650  group 2 project oral presentation for the role of a compliance offi...HCAD 650  group 2 project oral presentation for the role of a compliance offi...
HCAD 650 group 2 project oral presentation for the role of a compliance offi...
 
Hippa training v2
Hippa training v2Hippa training v2
Hippa training v2
 
Compliance planning for hipaa 2
Compliance planning for hipaa 2Compliance planning for hipaa 2
Compliance planning for hipaa 2
 
Compliance with Stark laws
Compliance with Stark lawsCompliance with Stark laws
Compliance with Stark laws
 
In Module One, our first step is to direct our focus on what healt
In Module One, our first step is to direct our focus on what healtIn Module One, our first step is to direct our focus on what healt
In Module One, our first step is to direct our focus on what healt
 
What explains why certain services were covered and others were not .docx
 What explains why certain services were covered and others were not .docx What explains why certain services were covered and others were not .docx
What explains why certain services were covered and others were not .docx
 
The Challenges Of Investigating Healthcare Fraud Cases | Health 2.0 Conference
The Challenges Of Investigating Healthcare Fraud Cases | Health 2.0 ConferenceThe Challenges Of Investigating Healthcare Fraud Cases | Health 2.0 Conference
The Challenges Of Investigating Healthcare Fraud Cases | Health 2.0 Conference
 
Legal Aspects of OH Article
Legal Aspects of OH ArticleLegal Aspects of OH Article
Legal Aspects of OH Article
 
Ethical nd legal isssues in nursing
Ethical nd legal isssues in nursingEthical nd legal isssues in nursing
Ethical nd legal isssues in nursing
 
MS.CAPSTONE
MS.CAPSTONEMS.CAPSTONE
MS.CAPSTONE
 
Regulating Healthcare - Lecture C
Regulating Healthcare - Lecture CRegulating Healthcare - Lecture C
Regulating Healthcare - Lecture C
 
How To Detect And Prevent Healthcare Fraud? | Health 2.0 Conference
How To Detect And Prevent Healthcare Fraud? | Health 2.0 ConferenceHow To Detect And Prevent Healthcare Fraud? | Health 2.0 Conference
How To Detect And Prevent Healthcare Fraud? | Health 2.0 Conference
 
Healthcare - Customer-Centric Healthcare Best Practices for CIO and CISOs
Healthcare - Customer-Centric Healthcare Best Practices for CIO and CISOsHealthcare - Customer-Centric Healthcare Best Practices for CIO and CISOs
Healthcare - Customer-Centric Healthcare Best Practices for CIO and CISOs
 

More from complianceonline123

Sec what you need to know
Sec what you need to knowSec what you need to know
Sec what you need to know
complianceonline123
 
Auditing your grc programs
Auditing your grc programsAuditing your grc programs
Auditing your grc programs
complianceonline123
 
Workplace harrasment
Workplace harrasmentWorkplace harrasment
Workplace harrasment
complianceonline123
 

More from complianceonline123 (20)

Fda adverse event reporting requirements for otc drugs
Fda adverse event reporting requirements  for otc drugsFda adverse event reporting requirements  for otc drugs
Fda adverse event reporting requirements for otc drugs
 
Social media risks rules policies procedures
Social media risks rules policies  proceduresSocial media risks rules policies  procedures
Social media risks rules policies procedures
 
Fmla ada overlap
Fmla  ada  overlapFmla  ada  overlap
Fmla ada overlap
 
Hipaa enforcement examples
Hipaa enforcement examplesHipaa enforcement examples
Hipaa enforcement examples
 
Excel spreadsheets how to ensure 21 cfr part 11 compliance
Excel spreadsheets  how to ensure 21 cfr part 11 complianceExcel spreadsheets  how to ensure 21 cfr part 11 compliance
Excel spreadsheets how to ensure 21 cfr part 11 compliance
 
Retail loss
Retail lossRetail loss
Retail loss
 
Hipaa privacy rule
Hipaa privacy ruleHipaa privacy rule
Hipaa privacy rule
 
Fda warning letters
Fda  warning lettersFda  warning letters
Fda warning letters
 
Dietary supplement
Dietary supplementDietary supplement
Dietary supplement
 
Out in the open protecting your privacy in the digital age
Out in the open  protecting your privacy in the digital ageOut in the open  protecting your privacy in the digital age
Out in the open protecting your privacy in the digital age
 
Reaching Clean Power Plan Goals at No Cost: Securing the Smart Grid’s Potential
Reaching Clean Power Plan Goals at No Cost: Securing the Smart Grid’s PotentialReaching Clean Power Plan Goals at No Cost: Securing the Smart Grid’s Potential
Reaching Clean Power Plan Goals at No Cost: Securing the Smart Grid’s Potential
 
Audit Process: How to Successfully Plan Audit
Audit Process: How to Successfully Plan Audit Audit Process: How to Successfully Plan Audit
Audit Process: How to Successfully Plan Audit
 
Basics of internal audit
Basics of internal auditBasics of internal audit
Basics of internal audit
 
Free trade zones
Free trade zonesFree trade zones
Free trade zones
 
Sec what you need to know
Sec what you need to knowSec what you need to know
Sec what you need to know
 
Auditing your grc programs
Auditing your grc programsAuditing your grc programs
Auditing your grc programs
 
Aml non bank finanacial institutions
Aml non bank finanacial institutionsAml non bank finanacial institutions
Aml non bank finanacial institutions
 
Gdp how to manage documentation lifecycle
Gdp  how to manage documentation lifecycleGdp  how to manage documentation lifecycle
Gdp how to manage documentation lifecycle
 
Workplace harrasment
Workplace harrasmentWorkplace harrasment
Workplace harrasment
 
Good documentation practices
Good documentation practicesGood documentation practices
Good documentation practices
 

Medical necessity

  • 1. Medical Necessity - Primer on Key Legal Principles and Operational Compliance This webinar on the legal principles of 'Medical Necessity' will cover the compliance background and provide practical advice on how healthcare providers can understand and apply ‘medical necessity’ principles. Why Should You Attend: 'Medical Necessity' principles are a fundamental component of health care delivery and payment for both government and private health plans. Moreover, both individual and organizational providers face undesirable consequences if they do not learn and follow these principles. The consequences range from mere ‘warning notices’ to possible criminal charges. The objective of this 90-minute webinar is to provide a solid frame of reference for those who must deal with ‘medical necessity’ issues as part of their core job responsibilities. The session designed to provide historical and legal context that will help attendees understand the social and payment policies related to medical necessity determinations, as applied in our health care industry. The webinar also will analyze specific statutory and regulatory authorities that are the sources of most interpretive differences of what is or is not a ‘medically necessary’ item or service. Several, specific examples of clinical services will be discussed. Areas Covered in the Webinar: Legal Overview Examples of how payment reforms relate to ‘medical necessity’ Enforcement techniques and related sanctions Suggestions for reducing risks of denials, repayment obligations and other legal penalties Methods to educate and train providers and support personnel on ‘medical necessity’ Who will benefit: The following personnel in medical offices, hospitals, medical centers and clinics will benefit: Clinical Service Administrators Process Improvement Teams, especially Revenue Cycle and Patient Accounts Clinicians Compliance Professionals Financial Officers Physicians
  • 2. For more details visit us at: http://www.complianceonline.com/ecommerce/control/trainin gFocus/~product_id=703145