Case Study: Medical Necessity and Reasonable Expectations

Case Study, Denial Management, Medical Necessity, Peer-to-Peer, Two-Midnight Rule / By

CLINICAL SUMMARY: A 73-year-old patient’s primary care doctor sent her to the Emergency Department (ED) after multiple labs taken for continuing chest pains showed abnormal results. The patient, who had been suffering chest pain for more than a week and who was taking nitroglycerin, had a stent placed in April. The patient had an extensive […]

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