Documenting What You Did: Demonstrate medical necessity and crack claim denials*

In recent years, third-party payers began changing their payment models to reflect value-based criteria. Under these payment models, healthcare providers must demonstrate high levels of quality care, efficiency and effectiveness. A key component of achieving these requirements is medical necessity. In this 90-minute webinar, the audience will learn how the role of medical necessity impacts coding/billing and why it is critical to the continued success of the practice under value-based payment systems. In addition, common documentation errors will be discussed with suggestions for improvement. By understanding medical necessity, OMS offices are more likely to create documentation policies and procedures that will help establish optimal payment and proper compliance.

*Indicates that this activity is approved by AAOMS for continuing dental education credit ONLY.

Learning Objectives

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

  1. Cite the difference between medically necessary and unnecessary care. 
  2. Define medical necessity. 
  3. Discuss the role of medical necessity in value-based payment models. 
  4. Identify general documentation guidelines that help establish medical necessity. 
  5. Locate common E/M documentation errors. 
  6. Report common documentation errors related to OMS surgeries. 
  7. Explain the role of clinical documentation improvement (CDI) in reducing medical necessity denials. 

Dawn Jackson, DrPH, RHIA, CCS-P, FAHIMA
Eastern Kentucky University
Richmond, Ky.
Relevant Conflict of Interest Disclosure: No Relevant Conflict of Interest Disclosures were reported.

An Internet-based CDE Activity
Original Release Date: May 22, 2019
Expiration Date: May 22, 2022
Estimated time to complete this educational activity: 1.5 hours
Method of participation: Self-Study

Dawn Jackson, DrPH, RHIA, CCS-P, FAHIMA

Dr. Dawn Jackson is a former professor and program director of the Health Services Administration program at Eastern Kentucky University. She obtained her bachelor’s degree in Health Information Management from East Carolina University, Greenville, N.C., her master’s degree in Allied Health Education from Eastern Kentucky University, Richmond, Ky., and a doctorate degree in Health Services Management from the University of Kentucky, Lexington, Ky. She also is a fellow with the American Health Information Management Association. 
Dr. Jackson’s areas of expertise include healthcare reimbursement systems, coding and billing processes, medical law and healthcare management. A certified coding specialist, she has trained physicians and their staff for more than 26 years and has presented coding courses for the American Association of Oral and Maxillofacial Surgeons for almost 23 years.


Faculty and Planner Disclosure
4 Questions  |  1 attempt  |  0/4 points to pass
4 Questions  |  1 attempt  |  0/4 points to pass
Documenting What You Did: Demonstrate medical necessity and crack claim denials
Open to view video.
Open to view video.
4 Questions  |  Unlimited attempts  |  3/4 points to pass
4 Questions  |  Unlimited attempts  |  3/4 points to pass
11 Questions
1.50 CDE credits  |  Certificate available
1.50 CDE credits  |  Certificate available