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Instructions: Over the past several months the department has seen an increase in claim denials due to medical necessity issues. After reviewing the denials, you
Instructions: Over the past several months the department has seen an increase in claim denials due to medical necessity issues. After reviewing the denials, you realized the HIM professionals are not reviewing the National Coverage Determination (NCD) or Local Coverage Determination (LCD) to ensure proper documentation and medical necessity is met before providing and billing these services. To ensure your HIM professionals are following proper procedures and policies you will create a Frequently Asked Questions (FAQ) training document. We have provided the questions that should be included in your FAQ Training document. Please include all four parts in your document. Example: Part I: NCD's Question: What is the purpose, significance, and impact on reimbursement decisions? Answer: please provide answer. PART I: For NCD's answer the following questions: What is the purpose, significance, and impact on reimbursement decisions? What factors do CMS consider in making decisions? What is the impact on providers, payers, and patients? What is the impact on fraud and abuse detection? PART II: For LCD's answer the following questions: What is the purpose, significance, and impact on reimbursement decisions? What factors do CMS consider in making decisions? What factors do MAC's need to consider in making decisions? What
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