Common use of Physician and Medical Services Clause in Contracts

Physician and Medical Services. Medically Necessary inpatient physician and medical services provided by or under the direction of the attending health care provider and ordinarily furnished to a patient while hospitalized. Payment for Ancillary Services may not be denied solely based on the fact that the denial of the hospitalization day was appropriate. Instead a denial of inpatient Ancillary Services must be based on the Medical Necessity of the specific Ancillary Service. In determining the Medical Necessity of an Ancillary Service performed on a denied hospitalization day, consideration must be given to the necessity of providing the Ancillary Service in the acute setting for each day in question.

Physician and Medical Services. Medically Necessary inpatient physician and medical services provided by or under the direction of the attending health care provider and ordinarily furnished to a patient while hospitalized. SAMPLE Payment for Ancillary Services may not be denied solely based on the fact that the denial of the hospitalization day was appropriate. Instead a denial of inpatient Ancillary Services must be based on the Medical Necessity of the specific Ancillary Service. In determining the Medical Necessity of an Ancillary Service performed on a denied hospitalization day, consideration must be given to the necessity of providing the Ancillary Service in the acute setting for each day in question.