Medical Fraud or Medical Necessity: Documenting Your Story

Lorman Education Services
Training overview
Professional Course
Self-paced Online
1 hour
From 149 USD
Start dates
149 USD
Start anytime

Course description

Medical Fraud or Medical Necessity: Documenting Your Story

Gain an understanding of medical necessity and the importance of correct documentation.

The difference between the government making a determination of medical fraud as opposed to medical necessity lies in your documentation. Physicians, hospitals, labs, long-term care providers, and all other medical providers must properly document that their services were medically necessary. This course will inform providers, compliance professionals, and billers of the meaning and interpretation of the term medical necessity. The course will also provide guidance for properly documenting the procedures and services performed. To better understand the impact of proper documentation of medical necessity, this material will focus on recent government prosecutions and settlements, particularly in areas of increased government focus, such as telehealth services. Gain practical tips and considerations for documenting medical necessity.

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Who should attend?

This live webinar is designed for medical records directors, health information directors, coders, business managers, office managers, nurses, hospital administrators, billing managers, social workers, counselors, release of records professionals, and compliance managers.

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Training content

The Definition and Application of the Term Medical Necessity

  • Medical Necessity as Defined by CMS
  • Medical Necessity as Defined by States
  • Medical Necessity as Defined by the Courts

Appropriately Documenting Medical Necessity

  • Document Type, Frequency, Extent, and Duration
  • Standards of Practice
  • Evaluation and Diagnosis Codes

Lessons Learned From Recent Government Prosecutions

  • Overview of Recent Cases
  • Potential Defenses

Practical Considerations

  • Policies
  • Internal Audits
  • Results: Effective Communication, Correct and Timely Reimbursement, and Patient Safety

Certification / Credits


Learning Objectives

  • You will be able to define the term medical necessity.
  • You will be able to discuss appropriately documenting medical necessity.
  • You will be able to review lessons learned from recent government prosecutions.
  • You will be able to review practical considerations.

About Lorman Education Services

Lorman Education Services - Live and On-Demand Courses

Lorman Education Services is a leading provider of online professional development and corporate training for organizations and individual professionals. For more than 30 years, Lorman has delivered relevant, high-quality, professional-level courses that cover a broad range of business and technical...

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Contact info

Lorman Education Services

Lorman Education Services
2510 Alpine Road
54702 Eau Claire Wisconsin

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