CMS and others, such as some BCBS carriers, undergo a rigorous process to determine whether services are
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Question:
CMS and others, such as some BCBS carriers, undergo a rigorous process to determine whether services are appropriate for reimbursement based on a definition of the medical necessity of services. Highmark BCBS has reasoned that a service must meet five criteria to be paid. Discuss those criteria? Include in your discussion if you think they are reasonable or unreasonable and why?
Related Book For
Financial Accounting
ISBN: 978-0078025549
3rd edition
Authors: J. David Spiceland, Wayne Thomas, Don Herrmann
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