Medical Necessity Checking
The InsightCS® Medical Necessity Checking software system is an integrated solution to automate the process of compliance checking within the scheduling processes of tests/procedures. This solution also fully supports applicable medical necessity rules and conflict checking.
The user scheduling the test/procedure is not required to access external applications or go through additional steps during the process. The check between the procedure and patient’s ICD9-CM is performed automatically by the system, when a test is entered on a patient that meets the facility defined patient type and payer (financial class). If the test fails, an ABN form can be printed for the patient to sign. Optionally, by using Document Management, the ABN form can be scanned into the patient’s permanent record.
Features and Benefits
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Knowledge database defines valid ICD9-CM codes for each procedure code
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Provide and support knowledge database from a third party vendor
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Ability to define patient types for Medical Necessity check at scheduling time
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Ability to define payers (financial class) requiring Medical Necessity requirements at scheduling time
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Print ABN (Advanced Beneficiary Notice) for rejections
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ABN includes short explanation of form, all tests that are denied, reason for believing Medicare will deny service for each test, patient demographic information and a line for filling in beneficiary’s name, Medicare #, date of service and a place for signature
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Medical Necessity procedure completion and pass/fail results documented and stored in each patient's scheduled test/procedure
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On-line ICD9-CM Code lookup
NOTE: The ICD9-CM knowledge database is supplied to Stockell Healthcare by a third party vendor. We release updates of this information to our clients on a quarterly basis.