Welcome to season 2 of TCG. In my first episode we lay out how to level the playing field with payers and we did this! Here is what is included in this episode:
1. Ex-post Facto Guidelines and Laws
2. Understanding Payer Participation Agreements
3. Breakdown of Clinical Judgement, Medical Necessity, and The Treating Physician Rule
4. AMA Definition of Risk When Clinical and Non-Clinical Reviews are Deployed by Payors
5. Breakdown of Reasonable, Appropriate and Necessary
