Know medical necessity, get it right from the start

December 1, 2008 Diagnostic Imaging. Vol. 30 No. 12 Know medical necessity, get it right from the start Meeting challenges of coverage requires understanding of terminology and practices BY JEFF MAJCHRZAK, RCC, BA, RT(R), CNMT Mr. Majchrzak is vice president of radiology services at Medical Learning, Inc. (MedLearn) in St. Paul. Increasing use of imaging services and rising costs for Medicare have not been kind to radiology providers. Congress has issued several mandates to the Centers for Medicare and Medicaid Services to control these costs and to ensure quality data. Unfortunately, there is nothing radiology providers can do about these requirements except deal with the end result, which often means less income. Radiology providers can do something, however, about the claims that Medicare and other third-party payers deny because the services billed are not considered to be medically necessary. There are steps you can take and management processes you can implement to reduce those denials. To do this, of course, requires a little elbow grease and cooperation on the part of referring providers as well as your testing facility's radiologists and staff.

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