How To Document Medical Necessity
This week we wanted to discuss the need or LACK of need for Criteria, since there’s been talk lately about whether you even NEED to have InterQual or Milliman. BUT… The Criteria folks couldn’t join us, so you’ll have to settle for a future article or interview, a result of our research. Suffice to say, you NEED all the tools you can get to support Medical Necessity — you know, that thing that won’t go away… like the images from the movie “Jaws” that won’t let you go in the water when you go to the beach, ever since you saw the movie? (No? Maybe it’s just me.)
Instead, we discussed HOW TO DOCUMENT APPROPRIATELY in support of both determining and documenting appropriateness and medical necessity for hospital care (as CMS seems to want to call it now…).
Deepak Pahuja, MD FACP, CEO & Chief Medical Officer for Aerolib Healthcare Solutions joined us. Dr. Pahuja talked about what he teaches Physicians about how to make sure they document correctly for Medical Necessity. As an experienced Hospitalist and auditor, Dr. Pahuja is able to give an unusual perspective, even including CDI and clinical coding. And trust me — he has much more to say than we can get into on the show this week!
The handouts for today’s show include slides from an upcoming webinar that will be offered in Appeal Academy’s Center for Compliance, as well as a follow-up 6-week Coaching Series from GPS, at gpsforhospitals.com.
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Click Here to Download an MP3 Audio Only version.