MEDICAL NECESSITY

MEDICAL NECESSITY

The Centers for Medicare and Medicaid Services (CMS) and the Office of the Inspector General (OIG) recognize that physicians and other authorized individuals must be able to order any tests that they believe are appropriate for the treatment or diagnosis of their patients. However, claims submitted for tests or services will only be paid if the service is covered, reasonable and necessary for an individual patient given his or her clinical condition.

AMS is committed to compliance in the area of medical necessity, and as such will continue to develop request forms, services guides and other educational material to assist physicians and their staff. AMS has a strong commitment to ensure that its business affairs are conducted in a manner consistent with the regulations of Federal, State and local governments. The AMS compliance program encompasses a broad range of regulations with special focus on reimbursement under government funded programs such as Medicare and Medicaid.