Medical Necessity using Soap can prevent a future audit!

by  Christine Taxin, President - Links2Success
Jun 15th, 2020

Medical Necessity using Soap can prevent a future audit!

How Do I Correctly Document all my notes on every patient regardless of the insurance I am billing?

Medically necessary care is the reasonable and essential diagnostic, preventive, and treatment services (including supplies, appliances, and devices) and follow-up care as determined by qualified health care providers, in treating any condition, disease, injury, or congenital or developmental malformation. includes all supportive health care services that, in the judgment of the attending dentist, are necessary for the provision of best quality therapeutic and preventive oral care.

Dental care is medically necessary to prevent and cut orofacial disease, infection, and pain, to restore the form and function of the dentition, and to correct facial disfiguration or dysfunction.

The term clinical medical necessity is also often used. Health insurance companies supply coverage only for health‐related related services that they define or determine to be medically necessary.

Use a SOAP outline that will explain to any insurance company the reasons for treatment.  This should always be used to prevent the documentation from being completed incorrectly. 

All documentation is not just used to prove medical necessity but to show that the provider provided the treatment with the correct information and followed the rules of documentation needed to prevent an audit, which could turn your life upside down.

Here are some examples of what some third-party payers are currently including in their medically necessary verbiage:

• Treatment is consistent with the symptoms or diagnosis of the illness, injury, or symptoms under review by the provider of care.
• Treatment is necessary and consistent with accepted professional medical standards (i.e., not experimental, or investigational).
• Treatment is not given primarily for the convenience of the patient, the attending provider, or other provider or supplier.
• Treatment is given at the most correct level that can be supplied safely and effectively to the patient and is neither more nor less than what the patient is needing at that specific point in time.
• The disbursement of medical care and/or treatment must not be related to the patient’s or the third-party payer’s monetary status or benefit.
• Documentation of all medical care should accurately reflect the need for and outcome of the treatment.
• Treatment or medical services deemed to be medically necessary by the provider of those services,(e.g., dentist, therapist, clinician, etc.) does not imply or infer that the service(s) provided will be covered by or deemed a medically necessary service payable by a third-party insurance payer.
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