As recovery audit contractors set their sites on medical necessity of inpatient stays, hospitals enter a hazy area of compliance. RAC consultants say Medicare definitions of what constitutes inpatient ...

Following authorization from CMS on Aug. 6 to begin medical necessity reviews of 18 types of medical conditions, three Medicare recovery audit contractors have announced the start of such review, ...

“Sometimes payer guidelines conflict with the AMA and CMS directives. In addition to staying up to date with different coding guidelines, providers must also be aware of guidance about when procedures ...

A U.S. District Court in Connecticut recently issued an order that highlights the importance of understanding exactly what the term “medically necessary” means in an ERISA health plan. 1 This is ...