Medical necessity: is current documentation practice and payment denial limiting access to inpatient rehabilitation?
Am J Phys Med Rehabil
; 88(9): 755-65, 2009 Sep.
Article
in En
| MEDLINE
| ID: mdl-19487918
ABSTRACT
Medical necessity is a legal, not medical, term. Depending on the stakeholder's point of view, it may seem less about human need and dispensing medical care and more about a web of rules, rulings, regulations, and manuals, especially for Medicare patients, who use the lion's share of rehabilitation services. In other words, the term medical necessity seems, to some stakeholders, to refer more to what determines payment by Medicare instead of what should be done to determine optimal patient health. Such a perspective on medical necessity has major implications, considering that Medicare pays for most of the rehabilitation treatment in some 1200 inpatient rehabilitation facilities and that its policies determine which patients qualify for admission to an inpatient rehabilitation facility. Medicare's medical necessity policies are often described by inpatient rehabilitation facility administrators and physiatrists as complicated and unfair, as well as being demeaning to the standing of physicians. Ask some physiatrists about their patients meeting Medicare guidelines for medical necessity, and they might bark, "Medical necessity?! That's what I was taught to know!"
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Rehabilitation
/
Rehabilitation Centers
/
Medicare
Type of study:
Guideline
/
Prognostic_studies
Limits:
Humans
Country/Region as subject:
America do norte
Language:
En
Journal:
Am J Phys Med Rehabil
Journal subject:
MEDICINA FISICA
/
REABILITACAO
Year:
2009
Type:
Article
Affiliation country:
United States