W4: Analyze The Process Of Reviewing Medical Documentation

Medical Necessity
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Introduction
This essay aims to present a reflective analysis over the topic of the importance and influence of the medical necessity in the medical documentation, its coding and reimbursement. Moreover, the assessment of the procedure of the documentation in the medical provisions along with the evaluation of the significance of the quality control in the entire process will also be discussed by means of the reflective perception. Noting that, the medical necessity is a procedure of decision making made by a healthcare practitioner which includes the diagnostic approaches, therapeutic interventions, medication procedures and other medical explanation and details of a patient developed by proper planning by means of authentic medical policies in a medical setting (Massry, 2011).
Discussion
Strategies and the explanations behind performing them are the core element of therapeutic need and it is the job of the coder and biller in a medical provision to legitimately clarify them in a case by choosing the right and relevant codes. Consequently, if a professional requires support and coordination from the payer during installments, at that point he or she should ensure that the purpose for each methodology a medicinal expert performs is legitimate (Hill, 2012). For instance, if the developed code for the diagnosis determines a fractured foot then the payer is only asked to pay for that, and will not be made to pay for shoulder fix, regardless of whether both occurred at the same time (Massry, 2011).
The “Centers for Medicare and Medicaid Services (CMS)” has expressed that medicinal need of an administration is the overall paradigm for installment, notwithstanding the individual prerequisites of a CPT coding criteria. It is not considered to be restoratively fundamental or proper to charge a huge amount of assessment and the administration provision particularly when a less significant service is justi...