What is Medical Necessity?
SOURCE: A Chiro.Org Editorial
“There are almost as many definitions of medical necessity as there are payors, laws and courts to interpret them. Generally speaking, though, most definitions incorporate the principle of providing services which are “reasonable and necessary” or “appropriate” in light of clinical standards of practice. The lack of objectivity inherent in these terms often leads to widely varying interpretations by physicians and payors, which, in turn, can result in the care provided not meeting the definition.”
“Medical Necessity” is the slippery slope, according to the Physician’s News Digest
Medicare defines “medical necessity” as services or items reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
From an Insurers standpoint, this is why documentation of the patient encounter is so important. The standard note taking format for every patient encounter is the SOAP note. Medical (chiropractic) necessity is defined by your own notes. Let’s review what actually defines reasonable and necessary in the SOAP note:
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