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Training Tool: Medical necessity

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Published December 01, 2008

Editor’s note: This month’s training tool is provided by Khristine Anderson, training and data integrity specialist at Baptist Health South Florida, which includes seven hospitals in the Miami area. Baptist uses the following script for Medicare compliance and documenting medical necessity, which Medicare defines as services or items reasonable and necessary for the diagnosis or treatment of illness or injury. A provider who bills Medicare for services that Medicare deems not medically necessary can be prosecuted for fraud.This script is only a guide; departmental protocols should be followed for all circumstances not covered.


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