CMS Rulings Are Not Law; Yet Followed By ALJs
Lack of medical necessity is one of the leading reasons for denials during RAC, MAC, TPE, and UPIC audits. However, case law dictates that the treating physician should be allowed deference with the decision that medical necessity exists because the Medicare and/or Medicaid auditor never had the privilege to see the recipient. However, recent ALJ … Continue reading CMS Rulings Are Not Law; Yet Followed By ALJs
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