I’ve been thinking about Medical Necessity a lot lately.
    I’m presenting at a conference later this week on the topic of documenting medical necessity, which I’m pretty excited about and looking forward to the conversation with the attendees.  You may have also seen that I’m presenting material in a Webinar in April – and so its been central on my mind for a while.
    But really, I’ve spent a lot of years thinking about this topic.  
     
    Looking at Medical Necessity is an odd spot in the audit community.  That is because there is a soft point of (believe it or not) trying to steer clear of directing treatment through while evaluating whether or not a clinician has made a case for why treatment is occurring and whether or not psychotherapy is appropriate – or happening.  It forces the process through an objective evaluation of the components of documentation to ensure that the elements that lead us there are there.
    Medical necessity is not a sentence we add to a progress note saying we’re doing it, but instead it is at the core of what we are doing at all in psychotherapy.   It establishes the “what we are doing” and the “why we are doing it” from our first appointment through our last with the client.  It is related to the challenges the client is facing and the work we are doing together in order to alleviate or ameliorate them.
    There are specific pieces to accomplishing it.  Different clinicians struggle with the question of what those pieces are.  
    Why this sort of material isn’t directly covered in most of our graduate programs I’ll never quite understand.  It just isn’t.  
    But it’s so important to understand what it is and how we do it.  We want to make sure we’re involved in these discussions and clear about what we’re supposed to be doing.  Our business (if we take insurance reimbursement that is) really depends on it.