What role does evidence-based clinical criteria

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Reference no: EM132299420

Evaluate and examine medical necessity from a provider’s (doctor, hospital, clinic, etc.) point of a view and from a payer’s (Aetna, Cigna, Affinity, Healthfirst, etc.) point of view.

What role does evidence-based clinical criteria and guidelines play with regard to medical necessity?

Do you agree or disagree with the following statement? Why or why not?

“Medical necessity coverage guidelines… typically rely on evidence-based medical guidelines that take precedence over differing community-based practice standards or even the opinion of the treating physician.” (Kongstvedt, 2016)

Reference no: EM132299420

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