| Medical necessity: is current documentation practice and payment denial limiting access to inpatient rehabilitation? | |
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MedLine Citation:
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PMID: 19487918 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Medical necessity is a legal, not medical, term. Depending on the stakeholder's point of view, it may seem less about human need and dispensing medical care and more about a web of rules, rulings, regulations, and manuals, especially for Medicare patients, who use the lion's share of rehabilitation services. In other words, the term medical necessity seems, to some stakeholders, to refer more to what determines payment by Medicare instead of what should be done to determine optimal patient health. Such a perspective on medical necessity has major implications, considering that Medicare pays for most of the rehabilitation treatment in some 1200 inpatient rehabilitation facilities and that its policies determine which patients qualify for admission to an inpatient rehabilitation facility. Medicare's medical necessity policies are often described by inpatient rehabilitation facility administrators and physiatrists as complicated and unfair, as well as being demeaning to the standing of physicians. Ask some physiatrists about their patients meeting Medicare guidelines for medical necessity, and they might bark, "Medical necessity?! That's what I was taught to know!" |
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Authors:
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Carl V Granger; Marsha Carlin; Pedro Diaz; Jane Dorval; Steve Forer; Corby Kessler; John L Melvin; Lawrence S Miller; Richard V Riggs; Pamela Roberts |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: American journal of physical medicine & rehabilitation / Association of Academic Physiatrists Volume: 88 ISSN: 1537-7385 ISO Abbreviation: Am J Phys Med Rehabil Publication Date: 2009 Sep |
Date Detail:
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Created Date: 2009-08-20 Completed Date: 2009-09-23 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8803677 Medline TA: Am J Phys Med Rehabil Country: United States |
Other Details:
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Languages: eng Pagination: 755-65 Citation Subset: AIM; IM |
Affiliation:
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Department of Rehabilitation Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Amherst, NY 14228, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Continuity of Patient Care
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economics,
legislation & jurisprudence Humans Medicare / economics*, legislation & jurisprudence Prospective Payment System / economics, legislation & jurisprudence Rehabilitation / economics*, legislation & jurisprudence Rehabilitation Centers / economics*, ethics* United States |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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