Coding Vs. Auditing: Does It Boil Down To Medical Necessity?
Coders are taught very strict guidance and rules of code selection look-up, proper order of selection, and linking codes correctly, but the art of abstracting medical necessity from the documentation is often-times not taught until one reaches the world of auditing. This creates problems in that coders typically assign the codes prior to claim submission which may mean that medical necessity is not evaluated. During this session, we will explore this difference and how to ensure that medical necessity can be extrapolated through all areas of coding and auditing. In this session, Our expert speaker Shannon DeConda, CPC, CPC-I, CEMC, CEMA, CPMA, CRTT will define medical necessity, outline the fundamentals along with the myths and misconceptions of medical necessity, and provide attendees with take away steps of how to ensure proper development and implementation of these concepts within their own team. Areas Covered In The Session: Define the roles and duties of the coder according to noted resources Define the roles and duties of the auditor according to noted resources Define medical necessity – (1) What is the role of medical necessity? (2) How can a non-clinician auditor validate the clinician? (3) Myths and misconceptions associated with medical necessity. The fundamentals of medical necessity for coders – (1) Why is this necessary? (2) Why don’t they know? Transferring medical necessity into the next phases in the ever-changing healthcare horizon
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