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The treating physician rule involves the legal precept that the treating doctor, who has examined the patient and is most conversant in the affected person’s situation, is in the most effective position to make medical necessity determinations. The treating physician rule, as adopted by some courts, reflects that the treating doctor’s dedication that a service is medically needed is binding except contradicted by substantial proof, and is entitled to some further weight, even if contradicted by substantial evidence, as a result of the treating physician is inherently more accustomed to the patient’s medical situation. As famous above, RACs utilize the services of registered nurses (moderately than physician reviewers) to conduct reviews regarding medical necessity. Suppliers and suppliers should reference the treating physician rule to display that the treating physician’s medical judgment as to the medical necessity of the providers supplied needs to be given deference.
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