A billing and coding specialist is preparing an appeal letter in response to a denial by a third-party payer for lack of medical necessity. Which of the following should the specialist include with the letter to indicate medical necessity?

Including medical record documentation with the appeal letter is essential to substantiate the claim that the services provided were medically necessary. This documentation serves as concrete evidence that supports the reason for the treatment, illustrating how it aligns with established guidelines and standards of care. It typically includes the patient's medical history, relevant diagnostic tests, treatment plans, and progress notes, all of which provide a comprehensive view of the patient's condition and the rationale behind the treatment decisions made by the healthcare provider.

While other elements, such as insurance policy details or copies of previous claims, may provide some context, they do not directly address the fundamental issue of medical necessity that the third-party payer identified in the denial. Patient identification information is necessary for documentation but does not pertain to the assessment of medical necessity. In summary, presenting thorough medical record documentation is critical to effectively counter the denial and demonstrate that the services rendered were, in fact, warranted based on the patient's specific health needs.