NW1005B: CONTINUING ED CHRONICLE™

UTILIZATION REVIEW PART 2B: MAKING SENSE OF HEALTH CARE DENIALS

TAKE PART 2A NOW !
TAKE PART 2B NOW !

OBJECTIVES

1. Define and Discuss the concept of Medical Necessity as it relates to Medicare beneficiaries.
2. Define and compare National Coverage Determinations (NCDs) and Local Medical Review Policies (LMRPs)
3. Discuss Medicare Statute, Regulations, and Policies as they relate to:

1. Diagnosis
2. Treatment
3. Skilled Nursing Care
4. Home Care
5. Durable Medical Equipment

OUTLINE

Article #1: Making Sense of Health Care Denials

Article #2: Partnership for Solutions: Better Lives for People with Chronic Conditions

A. Necessity and benefits

B. Denials

C. Liability for coverage

D. Appeals

E. Take charge