Who Decides Medical Necessity For Mental Health?   Massachusetts State Bill Challenges Notion

Massachusetts bill (H 1070/S 1093) adds to the definition of “medically necessary services” and challenges the notion of who decides medical necessity. Medical necessity criteria sits at the center of case and claim determinations. Laws, policies, and procedures evolve through time and the various administrations both locally and nationally.

Levels Of Care Coordination

Medical Necessity and Levels of Care (LOC) criteria are interdependent sets of objective and evidence-based health guidelines used to standardize coverage determinations, promote evidence-based practices, and support a patient’s recovery and well-being. Being such, LOC application, documentation, and accuracy plays a pivotal role in care and reimbursement.

5 Issues Associated With Medical Necessity

Medical Necessity | Edits There are few things more frustrating to a physician than a pile of Medical Necessity edits. Medical Necessity is the term we use in healthcare to describe care what is reasonable and appropriate for a patient based on evidence-based care standards. This has become something of a major bone of contention between payers and physicians, because, often times, physicians don’t understand why their clinical judgment is being brought into question.

4 Level of Care Tools | Comparing Level of Care Assessment

What do ASAM®, LOCUS®, CALOCUS®, and InterQual® all have in common? They are all level of care assessment tools, each with a different perspective. Level of care isn’t a new concept, but has gained in popularity in recent years. A level of care is used to indicate a level of intensity or severity and determine in what type of facility specific care should be performed. It is used to make sure the patient receives the right care in the right facility at the right time.

2017-06-26T16:14:20+00:00 By |Clinical Analysis, Services|

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