Which of the following is required to establish medical necessity on the patient encounter form? ✅ Mới nhất
Thủ Thuật về Which of the following is required to establish medical necessity on the patient encounter form? Chi Tiết
Dương Gia Minh đang tìm kiếm từ khóa Which of the following is required to establish medical necessity on the patient encounter form? được Update vào lúc : 2022-09-06 16:10:06 . Với phương châm chia sẻ Mẹo về trong nội dung bài viết một cách Chi Tiết Mới Nhất. Nếu sau khi tham khảo nội dung bài viết vẫn ko hiểu thì hoàn toàn có thể lại Comments ở cuối bài để Admin lý giải và hướng dẫn lại nha.Cigna defines Medical Necessity in the following four ways:
- Medical Necessity for PhysiciansMedical Necessity for other Health Care ProvidersHealth Care for Seniors Definition of Medical Necessity for PhysiciansHealth Care for Seniors Definition of Medical Necessity for other Health Care Providers
Full descriptions of each are given below.
Nội dung chính- Cigna defines Medical Necessity in the following four ways:Cigna's Definition of Medical Necessity for
PhysiciansCigna's
Seniors Definition of Medical Necessity for other Health Care ProvidersCigna's Seniors Definition of Medical Necessity for PhysiciansCigna's Seniors Definition of Medical Necessity for other Health Care ProvidersMedical Necessity Criteria for Treatment of Mental Health and Substance Use DisordersWhich of the following is the purpose of the encounter form?Which of the following documents must a medical administrative assistant provide for a patient to submit for reimbursement?When a patient requires a diagnostic procedure which of the following is required?What is a patient encounter form quizlet?
Cigna's Definition of Medical Necessity for Physicians
"Medically Necessary" or "Medical Necessity" means health care services that a physician, exercising prudent clinical judgment, would provide to a patient. The service must be:
For the purpose of evaluating, diagnosing, or treating an illness, injury, disease, or its symptomsIn accordance with the generally accepted standards of medical practiceClinically appropriate, in terms of type, frequency, extent, site, and duration, and considered effective for the patient's illness, injury, or diseaseNot primarily for the convenience of the patient, health care provider, or other physicians or health care providersNot more costly than an alternative service or sequence of services least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury, or diseaseFor these purposes, "generally accepted standards of medical practice" means:
Standards that are based on credible scientific evidence published in peer-reviewed, medical literature generally recognized by the relevant medical communityPhysician Specialty Society recommendationsThe views of physicians practicing in the relevant clinical areaAny other relevant factorsPreventive care may be Medically Necessary, but coverage for Medically Necessary preventive care is governed by terms of the applicable Plan Documents.
Cigna's Seniors Definition of Medical Necessity for other Health Care Providers
Except where state law or regulation requires a different definition, "Medically Necessary" or "Medical Necessity" refers to health care services that a health care provider, exercising prudent clinical judgment, would provide to a patient. The service must be:
For the purpose of evaluating, diagnosing, or treating an illness, injury, disease, or its symptomsIn accordance with the generally accepted standards of medical practiceClinically appropriate, in terms of type, frequency, extent, site, and duration, and considered effective for the patient's illness, injury, or diseaseNot primarily for the convenience of the patient, health care provider, or other physicians or health care providersNot more costly than an alternative service or sequence of services least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury, or diseaseFor these purposes, "generally accepted standards of medical practice" means:
Standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical communityPhysician and Health Care Provider Specialty Society recommendationsThe views of physicians and health care providers practicing in relevant clinical areasAny other relevant factorsPreventive care may be Medically Necessary, but coverage for Medically Necessary preventive care is governed by terms of the applicable Plan Documents.
Cigna's Seniors Definition of Medical Necessity for Physicians
Except where state law or regulation requires a different definition, "Medically Necessary" or "Medical Necessity" refers to health care services that a health care provider, exercising prudent clinical judgment, would provide to a patient. The service must be:
For the purpose of evaluating, diagnosing, or treating an illness, injury, disease, or its symptomsIn accordance with the generally accepted standards of medical practiceClinically appropriate, in terms of type, frequency, extent, site, and duration, and considered effective for the patient's illness, injury, or diseaseNot primarily for the convenience of the patient, health care provider, or other physicians or health care providersNot more costly than an alternative service or sequence of services least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury, or diseaseFor these purposes, "generally accepted standards of medical practice" means:
Standards that are based on credible scientific evidence published in peer-reviewed, medical literature generally recognized by the relevant medical community Physician Specialty Society recommendationsThe views of physicians practicing in the relevant clinical areaAny other relevant factorsPreventive care may be Medically Necessary but coverage for Medically Necessary preventive care is governed by terms of the applicable Plan Documents.
Cigna's Seniors Definition of Medical Necessity for other Health Care Providers
Except where state law or regulation requires a different definition, "Medically Necessary" or "Medical Necessity" shall mean health care services that a health care provider, exercising prudent clinical judgment, would provide to a patient. The service must be:
For the purpose of evaluating, diagnosing, or treating an illness, injury, disease, or its symptomsIn accordance with the generally accepted standards of medical practiceClinically appropriate, in terms of type, frequency, extent, site, and duration, and considered effective for the patient's illness, injury, or diseaseNot primarily for the convenience of the patient, health care provider, or other physicians or health care providersFor these purposes, "generally accepted standards of medical practice" means:
Standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical communityPhysician and Health Care Provider Specialty Society recommendations The views of physicians and health care providers practicing in relevant clinical areasAny other relevant factorsPreventive care may be Medically Necessary but coverage for Medically Necessary preventive care is governed by terms of the applicable Plan Documents.
Medical Necessity Criteria for Treatment of Mental Health and Substance Use Disorders
Cigna believes that all treatment decisions that are made in alignment with the Medical Necessity Criteria must be first and foremost clinically based. Care must be patient-centered and take into account the individuals’ needs, clinical and environmental factors, and personal values.
Learn more about our Behavioral Health Guidelines.