Non-Medically Necessary vs. Statutorily Excluded Services: Understanding the Differences

Compliance, CPT, Payer Rules, Practice Management, Procedural Coding & Auditing, Revenue Cycle Management

Non-Medically Necessary vs. Statutorily Excluded Services: Understanding the Differences  Written by: Jennifer McNamara “That’s not covered.” It’s a phrase we hear all the time—but what does it really mean? There’s a definite distinction between non-medically necessary services and those that are statutorily excluded.  Understanding the difference between non-medically necessary and statutorily excluded services is essential…

Prevention of Patient Complaints and Payer Denials: Covered vs Non-Covered Preventive Services

Compliance, CPT, Payer Rules, Practice Management, Procedural Coding & Auditing, Revenue Cycle Management

Prevention of Patient Complaints and Payer Denials: Covered vs Non-Covered Preventive Services Written by: Pam Vanderbilt “I just got a bill for my free annual visit!!   Sound familiar? Calls from patients who are upset because they got a bill for services they thought were covered. When I research these complaints, the issue causing the services…

Understanding the Core Purpose of Certificate Of Need Regulations

Compliance, CPT, E/M Coding & Auditing, Payer Rules

Understanding the Core Purpose of Certificate Of Need Regulations Written by: Trevor McElhaney, JD | Director of Consulting at DoctorsManagement, LLC What is a Certificate of Need? In the complex landscape of healthcare regulation, the Certificate of Need (CON) plays a significant role in determining the expansion and distribution of healthcare services. A Certificate of…