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Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
The use of cannabis (also known as marijuana) for medical purposes is a notable medical necessity case. Cannabis is a plant whose active ingredients are widely reported by patients to be effective in pain control for various conditions, usually neuropathic in nature, in which common painkillers have not had great benefit.
It is a form of utilization management and forms a medical guideline on treatment. Medicare coverage is limited to items and services that are considered "reasonable and necessary" for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category). [2]
Physician's News Digest article on Certificates of Medical Necessity; Statutory definition of a CMN at the SSA website; Medicare manual that provides exhaustive information about the practical use of CMNs, particularly section 5.3. This is the official source of information for contractors administering the Medicare system about the use of CMNs.
This page was last edited on 9 February 2024, at 17:16 (UTC).; Text is available under the Creative Commons Attribution-ShareAlike 4.0 License; additional terms may apply.
Family medical history FOH: Family ocular history F/U: Follow up appointment GH: General health G(M)P: General (medical) practitioner HA: Headaches HARC: Harmonious abnormal retinal correspondence HM: Hand motion vision – state distance Hx: History IOL: Intra-ocular lens IOP: Intra-ocular pressure ISNT: Inferior, Superior, Nasal, Temporal
Plates vi & vii of the Edwin Smith Papyrus (around the 17th century BC), among the earliest medical guidelines. A medical guideline (also called a clinical guideline, standard treatment guideline, or clinical practice guideline) is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of healthcare.
Figure 1.0 - Basic anatomical features of the human eye. Ophthalmic drug administration is the administration of a drug to the eyes, most typically as an eye drop formulation.