Case Management: Medical Necessity and Its Impact

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Medical necessity or medically necessary care are services that a physician, exercising prudent clinical judgment, provide to a patient. It is important to understand how medical necessity and proper status placement affects hospital payment and reimbursement.

This course will help identify vital elements in determining medical necessity of key diagnoses. Attendees will learn the definition of medical necessity and related tools, as well as how it’s applied to determine the correct patient status such as observation or inpatient status.


Learning Objectives:

  • Learn the definitions of observation status, inpatient status
  • Identify medical necessity criteria
  • Understand medical necessity impact on hospital payment and reimbursement

Who Should Attend:

  • Case Management Staff
  • Utilization Review Staff
  • Physicians