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The treating physician rule entails the legal precept that the treating doctor, who has examined the affected person and is most acquainted with the affected person’s situation, is in the best position to make medical necessity determinations. The treating doctor rule, as adopted by some courts, reflects that the treating physician’s willpower that a service is medically needed is binding unless contradicted by substantial proof, and is entitled to some extra weight, even when contradicted by substantial proof, as a result of the treating physician is inherently more familiar with the affected person’s medical condition. As famous above, RACs make the most of the services of registered nurses (reasonably than doctor reviewers) to conduct critiques relating to medical necessity. Suppliers and suppliers ought to reference the treating physician rule to reveal that the treating physician’s medical judgment as to the medical necessity of the services offered ought to be given deference.

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