Season 8 - Episode 7 - #TerryTuesday - Evaluation Medical Necessity

The Compliance Guy

Summary

In this episode, Sean and Terry discuss the intersection of sports and healthcare, particularly focusing on the implications of sports injuries on mental health. They delve into the nuances of preventative medicine visits, the complexities of evaluation and management services, and the importance of medical necessity in billing practices. The conversation highlights the challenges healthcare providers face in navigating these areas while ensuring compliance and quality patient care.

Takeaways

• The connection between sports injuries and mental health is significant.
• Preventative medicine visits can include additional work if abnormalities are found.
• Medical necessity is crucial in determining billing practices.
• Providers must ensure that services billed are significantly separate from preventative services.
• The guidelines for evaluation and management services have changed, adding complexity.
• Subjectivity in medical appropriateness can lead to confusion in billing.
• Patients often bring up additional concerns during preventative visits.
• Providers should be cautious about billing for services that may not be necessary.
• Documentation is key to supporting claims for additional services.
• Understanding payer expectations is essential for compliance.