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The treating physician rule includes the authorized precept that the treating physician, who has examined the affected person and is most familiar with the patient’s situation, is in the most effective position to make medical necessity determinations. Related Post: our site The treating doctor rule, as adopted by some courts, reflects that the treating doctor’s willpower that a service is medically essential is binding unless contradicted by substantial evidence, and is entitled to some extra weight, even when contradicted by substantial evidence, as a result of the treating doctor is inherently extra familiar with the patient’s medical situation. As famous above, RACs make the most of the companies of registered nurses (quite than physician reviewers) to conduct opinions concerning medical necessity. Providers and suppliers should reference the treating doctor rule to exhibit that the treating doctor’s medical judgment as to the medical necessity of the companies supplied needs to be given deference.
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