Medical Necessity: Navigate Documentation, Coding, and Billing Challenges - On-Demand

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Medical Necessity: Navigate Documentation, Coding, and Billing Challenges - On-Demand

Product Code: YHHA072319D

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Medical Necessity: Navigate Documentation, Coding, and Billing Challenges - On-Demand

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Available ON-DEMAND

Presented on: Tuesday, July 23, 2019

Presented by: Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC

Outpatient coders and providers can have completely different interpretations and definitions of medical necessity. Adding to the confusion, third-party insurance payers and Medicare have other understandings and applications of the term. It is crucial for facility coders, providers, and other revenue cycle professionals to clear up confusion surrounding medical necessity requirements for diagnoses and procedures to reduce their facility’s audit risk.  

Join expert speaker Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, as she explains how to find and interpret medical necessity requirements for local and national coverage determinations. Webb will review guidance from third-party payers who’ve recently added non-covered verbiage to their internal policies. Participants will be able to practice what they’ve learned through real-life medical necessity case studies and examples of denials and appeals. The program will be followed by a live Q&A.

As a bonus, participants will receive a medical necessity flow sheet for performing pre-authorizations and referrals, as well as query formatting templates used to clarify clinical documentation within the medical record. 

At the conclusion of this program, participants will be able to:

  • Define medical necessity as it relates to patients, payers, and providers
  • Ensure documentation aligns with reported CPT and ICD-10-CM codes
  • Explain documentation details necessary to prove medical necessity
  • Locate and interpret local and national coverage determinations
  • Recognize the relationship between coding and medical necessity


What is medical necessity?

  • The importance of medical necessity
  • Definitions for CMS, third-party payers, and physicians 

Third-party payers

  • Local coverage determinations
  • National coverage determinations
  • Specialty guidelines for non-covered procedures

Pre-authorization and referrals

  • Medical necessity denials
  • Medical necessity appeals

Documenting medical necessity in ICD-10-CM and CPT®

  • CDI—office/outpatient care
  • Important ICD-10-CM coding guidelines
  • CPT guidelines for multiple procedures performed on the same date

Query process

  • Review of the Advance Beneficiary Notice of Noncoverage
  • The coder’s role as a clinician educator

Case studies

  • Examples that do and do not reflect the need for treatment
  • Medically necessary verbiage



  • Medical necessity flow sheet for usage by clinical staff when performing pre-authorizations and referrals
  • Provider query template for clarifying clinical documentation within the medical record

Who Should Listen?

  • HIM directors and managers
  • Denial insurance managers
  • Coding managers and staff
  • Outpatient coders
  • Outpatient billers
  • Auditors
  • Finance staff and billers
  • Revenue cycle directors
  • Compliance officers
  • Chargemaster coordinators
  • Medical practice coders
  • CDI managers and staff
  • Office managers
  • Physicians
  • Physician assistants
  • Clinical nurse specialists
  • Revenue integrity staff  
  • Clinical staff
  • Nursing staff

Meet the Speaker

Lori-Lynne A. Webb

Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, AHIMA approved ICD-10-CM/PCS trainer, is an E/M and procedure-based coding, compliance, data charge entry, and HIPAA privacy specialist with more than 20 years of experience. Webb’s coding specialty is OB/GYN office/hospitalist services, maternal fetal medicine, OB/GYN oncology, urology, and general surgical coding.

Continuing Education

(Live + on-Demand) This program has the prior approval of AAPC for 1.5 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

Ability to claim credits for this webinar expires on: 07/22/2020

(Live + on-Demand) This program has been approved for 1.5 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).

Ability to claim credits for this webinar expires on: 07/22/2020

National Association of Healthcare Revenue Integrity (NAHRI)
This program has been approved for 1.5 continuing education units towards fulfilling the requirements of the Certification in Healthcare Revenue Integrity (CHRI), offered as a service of the National Association of Healthcare Revenue Integrity (NAHRI).



Webinar system requirements and program materials: 
To fully benefit from the webinar experience, please note you will need a computer equipped with the following:

Browser: Microsoft Internet Explorer 6 or later, Firefox, Chrome, or Safari, with JavaScript enabled 
Internet: 56K or faster Internet connection (high-speed connection recommended) 
Streaming: for audio/video streaming, Adobe Flash plug-in or Safari browser on iOS devices 

Prior to the webinar, you will receive an email with detailed system requirements, your login information, presentation slides, and other materials that you can print and distribute to all attendees at your location. 

No problem. The On-Demand version will be available. Use it as a training tool at your convenience—whenever your new or existing staff need a refresher or need to understand a new concept. Play it once or dozens of times. A $259 value! 

Participation in the webinar is just $259 per site. All materials must be retrieved from the Internet. 

Call your customer service representative toll-free 800-650-6787 or email if you have questions.