A fundamental tenet of healthcare billing compliance is that services must be medically necessary. The Social Security Act, Section 1862(a) (1) (A), states the following as it relates to Medicare: “No payment may be made under Part A or Part B for any expenses incurred for items or services not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.” And, many Medicare Administrative Contractors (MACs) explain similar requirements. For example, one administrative contractor has posted the following on their website.

Join for free to read