A __________occurs when a procedure and a diagnosis are not correctly linked, in the opinion of the payer.
A) redetermination
B) development
C) determination
D) medical necessity denial

Question

Quizplus · Accepted Answer

A medical necessity denial occurs when the payer believes that the procedure performed was not medically necessary based on the diagnosis provided. This means the procedure and diagnosis are not correctly linked in the payer's opinion, leading to a denial of the claim.

A __________Occurs When a Procedure and a Diagnosis Are Not