Discusses defining appropriate services

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Discusses defining appropriate services. CMS and others, such as some BCBS carriers, undergo a rigorous process to determine whether services are necessary for reimbursement based on a definition of the medical necessity of services. Highmark BCBS has reasoned that a facility must meet five criteria to be paid. Discuss those criteria? Include in your discussion if you think they are reasonable or unreasonable and why?

Reference no: EM132216589

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Discusses defining appropriate services : Discusses defining appropriate services. Highmark BCBS has reasoned that a facility must meet five criteria to be paid.

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