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The treating doctor rule involves the legal principle that the treating physician, who has examined the patient and is most conversant in the affected person’s condition, is in the most effective place to make medical necessity determinations. The treating physician rule, as adopted by some courts, reflects that the treating doctor’s willpower that a service is medically necessary is binding until contradicted by substantial evidence, and is entitled to some extra weight, even when contradicted by substantial proof, as a result of the treating physician is inherently more accustomed to the affected person’s medical situation. As famous above, RACs utilize the companies of registered nurses (slightly than doctor reviewers) to conduct opinions concerning medical necessity. Suppliers and suppliers ought to reference the treating doctor rule to reveal that the treating physician’s medical judgment as to the medical necessity of the companies supplied needs to be given deference.
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