A PICC line allows the medications to quickly reach the source of infection—but unfortunately, it also provides an easy route for the patient to use illegal drugs to get high. And sending an active or recent substance abuser home with a central line of any kind presents legal and ethical risks.
Q: We are trying to educate our coding department about medical necessity, but has CMS or Medicare defined it anywhere? How can we explain it to staff?
Q: Does a hospital need to obtain the patient's written consent before obtaining physician office notes? Can I contact the physician office and request the needed information without obtaining a written consent from the patient? The office notes are needed for payment purposes.
In the current healthcare climate, the issue of medical necessity documentation, or lack thereof, is one of the most common reasons for claim denials. For a service to be considered medically necessary (by a third-party payer), it must be considered a reasonable and necessary service to diagnose and/or treat a patient’s current and/or chronic medical condition.
This week's note explains and defines various policies enacted by the Bipartisan Budget Act of 2018, including policies related to outpatient therapy caps and the use of modifier -KX; the low-volume hospital adjustment; the Medicare dependent hospital program; and more. Updated March 2, 2018 for clarity on therapy cap exclusions.
