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Example of a Clinical Policy Bulletin

Clinical policy bulletins are used by Medicare Advantage plans and commercial payers to describe the services and procedures they cover and under what circumstances, says Denise Wilson, vice president of clinical audit and appeal services at AppealMasters in Towson, Maryland. “It describes the elements in the medical record that must be present in order for the payer to determine that the procedure or service was medically necessary,” she says. Contact Wilson at dwilson@intersecthealthcare.com.

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