What to do about increased denials and recoupments related to medical necessity–it’s an often-asked question at the annual American Health Lawyers Association’s (AHLA) Institute on Medicare and Medicaid (MMI) Payment Issues program. PYA Principal Denise Hall-Gaulin and Michael Spake, VP of External Affairs and Chief Compliance and Integrity Officer at Lakeland Regional Health, addressed this matter when they spoke at last year’s event. At the request of conference attendees, the pair were invited back for a “repeat performance” at this year’s program in Baltimore, Maryland, March 21-23.
Denise and Michael addressed the concerns for instituting best practices in tackling medical necessity denials as they co-presented “Medical Necessity—What It Means and a 2018 Update.”
Their presentation included:
- Medical necessity–what it means and what it affects.
- A 2018 update on CMS medical necessity determinations and new initiatives.
- Details regarding the types of, and criteria for, medical necessity determinations.
- Admission criteria for skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs).
- The use of Advanced Beneficiary Notification (ABN) and Hospital-Issued Notice of Non-Coverage (HINN), including the outcomes and penalties for not using ABNs or HINNs.
View the presentation below:
If you would like more information about medical necessity denials and recoupments, or would like to request a speaker on this topic for your organization or event, contact a PYA executive at (800) 270-9629.
