Medical Necessity determines if a health care service is reasonable, necessary, and appropriate based on clinical standards of care. It’s a key factor in determining eligibility for reimbursement. Nationally-recognized coding authority, Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, COC, walks you through what you need to know to ensure your documentation and coding will meet requirements for medical necessity.
Medical Necessity: Definition, Documentation and Billing
Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, COC
$79.00
CEUs: 1 1 AHIMA 1 AAPC
Included in eLearning Library. Price per person. Group rates available.Overview
Codes change yearly! We take seriously our obligation to provide you with accurate and up-to-date instruction. This course is updated for the 2025 code set.
Medical Necessity determines if a health care service is reasonable, necessary, and appropriate based on clinical standards of care. It’s a key factor in determining eligibility for reimbursement. Nationally-recognized coding authority, Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, COC, walks you through what you need to know to ensure your documentation and coding will meet requirements for medical necessity.
Medical Necessity: Definition, Documentation and Billing provides the learner with detailed guidance:
- How to navigate disagreements between provider and payer on what constitutes medical necessity
- Overcoming issues with finding the information on payer websites
- Explaining to the patient why they need a service that the payer says is not medically necessary
- The difference between medical necessity and medical decision-making
Medical Necessity: Definition, Documentation and Billing
- Define medical necessity
- The importance of diagnosis coding in reflecting medical necessity
- Guidelines and policies
- Documentation issues
- How to appeal medical necessity denials
- Tips for discussing medical necessity denials with providers and patients
- Review the compliant completion of Medicare Advance Beneficiary Notice (ABN)
The level of effort to complete this course, start to finish, is equivalent to 1 CEU and should take you approximately 1-3 hours to complete. Remember: You have access to the course materials for the full 4-week enrollment period and we encourage you to re-review any materials that are helpful to you.
Certificate of Completion
Upon successful completion of the course work, student will be able to download a Libman Education Certificate of Completion. The Certificate of Completion will list the course as awarding 1 CEU.
AHIMA: 1 CEU
This course has been approved for continuing education unit(s) (CEUs) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting of Approved CEUs from AHIMA does not constitute endorsement of the program content or its program provider.
AAPC: 1 CEU
This course has the prior approval of AAPC for continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.
- WebinarPlus™ multimedia and interactive online training format promotes engagement with challenging materials while offering independent self-study.
- Downloadable and printable “Course Highlights” saves time! This active learning tool assists with mastery of the course content.
- Teaching methods including audio and video files, diagrams, and animations to accommodate different learning styles. Where appropriate, the Merck Manual Professional Version supplements course materials with in-depth descriptions of diagnoses and/or procedures.
- Knowledge checks and/or final assessment ensure mastery of material.
- Online Flexibility! Materials available via secure Learning Management System (LMS). Work at your own pace — save time and travel costs.
- Earn Libman Education Certificate of Completion and CEUs.
- To receive CEU credit, students must achieve a passing rate on the course assessment(s).
- Course is self-paced. For planning purposes, assume 1-3 hours required for each CEU.
- Unlimited course access during enrollment period. For courses offering greater than one CEU, enrollment period is 16 weeks. For courses offering one or fewer CEUs, enrollment period is 4 weeks. Courses purchased as a bundle or package may have a longer enrollment period.
- Extensions to the enrollment period are available.
- Price listed is per person/per course. Group rates available upon request.
Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, COC
KGG Coding and Reimbursement Consulting, LLC
Kim Huey is an independent coding and reimbursement consultant, providing audit, training and oversight of coding and reimbursement functions for physicians. Kim completed three years of pre-medical education at the University of Alabama before she decided that she preferred the business side of medicine.
She completed a Bachelor’s degree in Health Care Management and went on to obtain certification through AAPC and AHIMA. Recognizing the important position of compliance in today’s environment, she has obtained certification as a Certified Professional Compliance Officer and has earned a Master of Jurisprudence in Health Law. Kim has authored numerous articles, spoken at local, state and national conferences and presented audioconferences related to the business side of medicine. Kim has worked with providers in virtually all specialties, from General Surgery to Obstetrics/Gynecology to Oncology to Internal Medicine and beyond. Kim can be reached at kim@kimthecoder.com
“The quality of the courses that Libman presents is excellent” — Pamela S., RN, BSN, MSN, CCDS, Director, Clinical Documentation Improvement, Sharp Healthcare
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“Libman Education is highly respected in the medical coding industry and offers over 60 online medical coding training classes. They have courses for beginners and advanced coding professionals who want to further their careers. Regardless of which medical coding certification you choose to pursue, Libman Education has courses that will prepare you. … We highly recommend you consider them.” — Clinical Coder Coaching
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“Libman has exceeded my expectations so far in every way, with the content of courses, but the hands on with the instructors is one of the best and most genius things to offer! All other companies I’ve seen in my 12 years in this field do not offer this invaluable service with their education. Answers to questions on education content is something that was desperately needed, but to my knowledge, it was/is not offered anywhere else and this is what sets Libman apart from the rest. Also, your high quality education and very knowledgeable instructors.” — coding student
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Required Resource:
- ICD-10-CM Code Book – 2025 or students may elect to use electronic files
- CPT® Code Book – 2025
Recommended Resources:
Current Procedural Terminology and HCPCS Coding for Physicians and Facilities by Kimberly Huey, CCS-P, PCS, MJ, CPC, CPCO, CHC, COC, is published by the American Health Information Management Association. The 2024 edition with an updated answer key and other materials to update to the 2025 code set is scheduled for release January 1, 2025.- Medical dictionary
- Anatomy and physiology reference
- Merck Manual
Train your entire team and Save Big! Discount automatically applied at checkout.
| How Many In Your Group? | Group Discount % |
|---|---|
| 1 | Retail Price |
| 2-4 | 5% Discount |
| 5-20 | 10% Discount |
| 21+ | Contact Us for Your Custom Price Quote |
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