Medical Necessity Reviews & CDI
Currently, we are working on a project aimed at developing a dedicated review process for patient charts, specifically for those prescribed new oncology treatment plans. We are approaching the process from a CDI perspective. Our goal is to ensure that all necessary documentation is provided by physicians to justify these complex treatment plans in the rapidly evolving field of precision oncology.
Some Challenges:
· Identifying obscure details within guidelines that permit the use of these agents in unusual circumstances.
· Difficulty navigating complex treatment plans and indications with Medicare Part A & B claims and identifying what constitutes medical necessity.
· Identifying appropriate query strategies when reaching out to providers, as the information we are looking for is quite different than the traditional CDI query.
Looking to collaborate.
Janae Schumacher
schumj@slhs.org