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The treating physician rule entails the legal principle that the treating physician, who has examined the patient and is most accustomed to the patient’s situation, is in the best position to make medical necessity determinations. The treating physician rule, as adopted by some courts, displays that the treating physician’s willpower that a service is medically obligatory is binding unless contradicted by substantial proof, and is entitled to some extra weight, even when contradicted by substantial evidence, as a result of the treating physician is inherently more familiar with the patient’s medical situation. As noted above, RACs utilize the providers of registered nurses (reasonably than doctor reviewers) to conduct opinions concerning medical necessity. Suppliers and suppliers should reference the treating physician rule to show that the treating physician’s medical judgment as to the medical necessity of the services supplied should be given deference.
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