Thursday, March 3, 2016

Reasonable and Necessary

“Reasonable and necessary” is a key principle in Medicare and Medicaid reimbursement.

“Reasonable and necessary” is a phrase used constantly by providers and the government.

“Reasonable and necessary” has never been fully defined, other than “you should know, ok?”

The federal government is using this standard to bring false claims and anti-kickback cases against providers.

More commentary will follow.


lee woo said...

The only thing necessary for the triumph of evil is for good men to do nothing. See the link below for more info.


Anonymous said...

Oh! So the standard has changed from reasonable and customary while I was not paying attention. I suppose customary is not always necessary, but my insurer paid at unreasonable and penurious rate.