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Last updated on April 20, 2014 at 14:04 EDT

Latest Medical necessity Stories

2013-09-30 23:35:14

As Cypress Benefit Administrators and its Argus Claim Review Division have reported in the past, medical necessity is becoming an issue consumers need to be aware of when considering their health care needs and reviewing the resulting medical claims. The U.S.-based third party administrator (TPA) specializes in employee benefits and shares a recent case study example where a patient was misdiagnosed and nearly received a $15,000 surgery that wasn’t medically necessary. Appleton, WI...

2012-07-27 10:22:04

New program may jeopardize access to mobility for Americans with disabilities WASHINGTON, July 27, 2012 /PRNewswire-USNewswire/ -- Four national organizations that advocate for people living with disabilities are urging the Centers for Medicare and Medicaid Services (CMS) not to implement a "prior authorization" program for power wheelchairs without including a clinical template for physicians to document patients' medical need for mobility equipment, reports the American Association for...

2012-06-19 02:27:34

Without Template, Access to Power Mobility Will Be Restricted for Medicare Beneficiaries WASHINGTON, June 19, 2012 /PRNewswire-USNewswire/ -- Power mobility stakeholders await implementation of a Medicare prior authorization program for power wheelchairs, an initiative that could address the flawed claims approval process that has hampered physicians and providers for years. If not implemented properly, the program will restrict access to power mobility devices for qualified Medicare...

2012-05-08 06:31:18

ATLANTA, May 8, 2012 /PRNewswire/ -- Craneware, Inc., the market leader in automated revenue integrity solutions, today announced the availability of new features to InSight Medical Necessity(®), its all-payor medical necessity verification solution. Because medical necessity is one of the greatest causes of denials today, representing a threat to provider organizations' revenue integrity, Craneware has enhanced InSight Medical Necessity to help healthcare organizations save staff time in...

2011-08-12 14:22:00

Properly Prescribed, Power Wheelchairs Prevent Falls and Keep Thousands of Seniors and People with Disabilities Safe and Independent at Home, Lowering Healthcare Costs for Taxpayers WASHINGTON, Aug. 12, 2011 /PRNewswire-USNewswire/ -- A July 2011 report by the U.S. Department of Health and Human Services Office of Inspector General (OIG) about power wheelchair usage in Medicare back in 2007 has resulted in misleading articles published in several media outlets, including USA Today....

2011-01-20 12:04:00

WASHINGTON, Jan. 20, 2011 /PRNewswire-USNewswire/ -- The State of the Medicare Mobility Benefit has never been more troubling, and perplexing. For much of the last decade, Congress and regulators implemented policies and regulations limiting the effectiveness of the Medicare benefit that is used by senior citizens and people living with disabilities to obtain power wheelchairs prescribed by their physicians. But a series of changes ranging from the so-called competitive bidding program to...

2010-04-08 17:40:00

Beneficiaries Paid to Fake Symptoms to Justify Medicare Billing WASHINGTON, April 8 /PRNewswire-USNewswire/ -- Detroit-area residents Carlos Grana and Dwight Armstrong pleaded guilty today to engaging in a fraudulent medical testing scheme, announced the Departments of Justice and Health and Human Services (HHS). Grana, 36, and Armstrong, 32, each pleaded guilty today to one count of conspiracy to commit health care fraud before U.S. District Court Judge Lawrence P. Zatkoff in the...

2009-09-23 07:00:00

NEWARK, CALIF., Sept. 23 /PRNewswire/ -- Novasys Medical, Inc., a developer of innovative therapies in women's health, announced today that Palmetto GBA and TrailBlazer Health Enterprises, LLC -- two large regional Medicare carriers serving over 10.2 million beneficiaries in California, Nevada, Hawaii, Texas, Oklahoma, Colorado, New Mexico and Virginia -- have agreed to cover the Renessa(R) treatment for female SUI (stress urinary incontinence) in appropriately selected patients with...

2008-07-17 00:00:35

SEATTLE _ Martin Martinez says the small, private collective and outreach group he runs from a storefront are legal, a place for medical-marijuana patients to get help growing the medicine they need to manage their pain. One of the earliest advocates for what became a voter-approved state medical-marijuana law 10 years ago, Martinez says he hasn't handed out pot, nor grown any in his cramped office. But Tuesday afternoon, Seattle police, armed with a search warrant, carted away marijuana...

2004-12-01 03:00:13

Traditional drugs have done little to help 39-year-old Angel Raich. Beset by ailments that include tumors in her brain, seizures, spasms and nausea, she has been able to find comfort only in the marijuana that is recommended by her doctor. On Monday, the Supreme Court will hear arguments in a case that will determine whether Ms. Raich and similar patients in California and 10 other states can continue to use marijuana for medical purposes. At issue is whether states have the right to...