Sample Medical Necessity Script

Steps to follow if Medical Necessity has not been met:

• Advise the patient: �This/These procedures did not meet medical necessity based on the diagnosis given.� 
  If the patient (pt) has concerns, advise him or her to contact the ordering physician. You may contact the physician's office, if requested by the patient, for any additional DXs at the time of service.

Pt refuses to sign ABN but demands to have test:

• Register the patient.
• Document the refusal in the ABN status.
• ABN must be witnessed by 2 associates.
• Enter condition code �20� on page 4.

Pt refuses to sign ABN and refuses test:

• Register the patient.
• Do not need consent signed.
• Document that patient left without having test done.
• Contact physician to notify him or her that the patient did not have test ordered and the pt was advised to discuss with the physician.

Pt signs ABN and has test:

• Register the patient.
• Have patient sign ABN.
• Enter condition code �20� on page 4.
• Attach ABN to Medical Record paperwork.

Pt signs ABN and refuses test:

• Register the patient.
• Patient signs ABN.
• Document patient left without having test done.
• Contact physician to notify them that the patient did not have test ordered and the pt was advised to discuss with the physician.

Source: Parrish Medical Center, Titusville, FL.