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The treating doctor rule involves the legal precept that the treating doctor, who has examined the patient and is most acquainted with the patient’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 essential is binding except contradicted by substantial proof, and is entitled to some additional weight, even if contradicted by substantial proof, as a result of the treating physician is inherently extra aware of the affected person’s medical situation. As noted above, RACs make the most of the providers of registered nurses (somewhat than doctor reviewers) to conduct critiques regarding medical necessity. Providers and suppliers ought to reference the treating physician rule to demonstrate that the treating physician’s medical judgment as to the medical necessity of the providers offered must be given deference.
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