Medical Necessity
Determining Status and Closing Documentation Gaps
In this course you will learn about the three components of medical necessity: severity of illness, risk of an adverse outcome, and the need for, availability and intensity of therapeutic intervention.
You will also practice applying them to reach an inpatient, observation or discharge decision.
You will also work with identifying the documentation gaps that leave a medically necessary admission open to denial at audit.
You will also practice applying them to reach an inpatient, observation or discharge decision.
You will also work with identifying the documentation gaps that leave a medically necessary admission open to denial at audit.
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Your Trainer
Hemant Gupta MD, MSc, CHCQM-PHY ADV -
Short, Focused Lessons
Theory and practice -
1 hour
Course duration -
Job Aid
Free of charge
What's included?
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14 Chapters
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Practical Exercises
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Tips and Advice
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Knowledge Checks
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Final Quiz
Decide with confidence
You will learn to break medical necessity down into its three components, rate each one for the patient in front of you, and reach an inpatient or observation decision you can explain and defend.
Document what you know
You will also learn to read a chart the way an auditor does, find the support already in the record, and name the specific sentence missing from the physician's note.
What will you learn?
Course Lessons
Meet the instructor
Hemant Gupta, MD
Dr. Gupta is a board-certified internal medicine physician, practicing hospitalist, and physician executive with more than 20 years of clinical and healthcare leadership experience.
He is a well-known and much appreciated speaker and trainer for physicians and hospital leaders on medical necessity, patient status and the documentation that supports it.
He is a well-known and much appreciated speaker and trainer for physicians and hospital leaders on medical necessity, patient status and the documentation that supports it.
Dr. Gupta earned his BS in Biology from Rensselaer Polytechnic Institute in 1996, his MSc in Chemistry from Tufts University in 1998, his MD from the University of Massachusetts Medical School in 2003, and completed his Internal Medicine residency at Rush University Medical Center in 2006.
Patrick Jones - Course author
Property of Clinical Review Academy, East Longmeadow, MA, USA
Hemant Gupta, MD
Hemant Gupta, MD
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