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The treating physician rule involves the authorized principle that the treating physician, who has examined the affected person and is most aware of 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 mandatory is binding until contradicted by substantial evidence, and is entitled to some additional weight, even if contradicted by substantial proof, as a result of the treating doctor is inherently extra acquainted with the patient’s medical situation. As famous above, RACs make the most of the services of registered nurses (somewhat than physician reviewers) to conduct critiques relating to medical necessity. Providers and suppliers should reference the treating doctor rule to display that the treating physician’s medical judgment as to the medical necessity of the providers supplied should be given deference.

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