Medicare's Enduring Struggle to Define “Reasonable and Necessary” Care

Neumann, Peter J.; Chambers, James D.

doi:10.1056/NEJMp1208386

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Medicare's Enduring Struggle to Define “Reasonable and Necessary” Care

Author(s): Peter J. Neumann , James D. Chambers

Publication date Created: November 08 2012

Publication date (Print): November 08 2012

Journal: New England Journal of Medicine

Publisher: Massachusetts Medical Society

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Abstract

Medicare legislation mandates that the program not pay for items and services that are not "reasonable and necessary" - terms that are open to interpretation and easily politicized. In today's fiscal environment, "reasonable and necessary" warrants a closer look.