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MEDICAL NECESSITY COMPLIANCE VERIFICATION PRODUCT
Your Solution for Medical Necessity ABN Compliance
Ask about our 30-day NO OBLIGATION, full install trial of the Premier Medical Necessity Compliance Verification software application.
Visit our Products section and see the many other products and services we can offer your hospital.
See why clients like Adventist Health, Asante Health and Banner Health of Colorado use our products.
All Premier Products are iSeries applications. Moving data to and from the iSeries platform is what we do best.
Call us at (801) 299-8772 ext. 118
Premier Medical Necessity ABN Compliance Software (PMN/ABN) provides user notification that payment on a claim, or a portion of a claim, may be denied because procedures reported on the account do not pass National Coverage Determination (NCD) or Local Medical Review Policy (LMRP) edits. PMN/ABN is an iSeries software application that seamlessly interfaces with MedSeries4® Patient Accounting and Billing applications to carry out these edits and provide user notification of edit results. Timely notification allows you to take corrective steps or to produce an Advance Beneficiary Notification (ABN) before services are provided.
What Our Users Tell Us...
"We have been using Premier's Medical Necessity product for the past three years. We worked with Premier to create the checker and a seamless flow of information from the physician's order to the ABN. This allowed us to meet CMS's specifications and regulations. We found the product to be cost-effective and it has reaped many financial benefits to our organization. We have been very pleased with Premier Software and their Medical Necessity product."
Karen Boone, Claims Reimbursement Supervisor Alamance Regional Medical Center Burlington, NC
Request our Free "Denial Analysis Report". It will identify procedures (and their cost) that you have already provided that may not be "Medically Necessary" based upon the NCDs and your Fiscal Intermediary's LMRPs.
"We were using another vendor when we changed over to Premier Software. Much to our delight, not only was the product doing what Premier promised it would, but the follow up and customer service was wonderful. When we have had questions regarding the software, we have experienced excellent response, most often the same day, as well as knowledgeable and courteous staff. We have been very pleased with our decision to go with Premier."
Shirley Jeffers St. Joseph Hospital Kokomo, IN
Premier Software's Medical Necessity Compliance Application Helps You Every Step of the Way
Pre-Admission Medical Necessity concerns may be identified before the patient arrives, allowing you to contact the physician to clarify the order or correct the coding. You may also notify the patient of the Medical Necessity issue before he arrives.
Registration If ordered procedures do not pass edits, an acceptable ABN must be produced and signed by the patient before treatment is provided. Notification at the time of registration allows you to produce an ABN that the patient may sign, cancel the procedure, or correct the coding.
Order Entry Medical Necessity editing may take place at the time an order is placed. This provides an additional opportunity to produce an ABN or take corrective steps before procedures are performed.
Coding Completion If coding is marked as complete and Medical Necessity issues are identified, the Medical Necessity notification screen displays. This assists medical records staff in ensuring that the coding has been done correctly.
Account Inquiries An account's Medical Necessity status may be viewed at any time after the account has been created. Access to this information through account inquiry functions also assists in ensuring that the coding has been done correctly.
Expected Reimbursement If a procedure does not pass edits, the charge associated with that procedure can automatically be identified as 'Non-Covered' in the calculation of expected reimbursement.
Billing Medical Necessity issues must be reported on claims. PMN/ABN automatically updates requiredoccurrence codes and CPT4 modifiers on your claims and provides new edits in your MS4 claim editor.
Available Reports
Physician Evaluation Listing A summary listing, sorted by physician that identifies the number of accounts for each physician in which a Medical Necessity Compliance failure was found.
Physician Account Evaluation Listing A detail listing, sorted by physician that identifies each account for which a Medical Necessity Compliance failure was found. Included in this report are account number, patient name, and discharge date.
Physician Evaluation Worksheet A single page for each account with at least one Medical Necessity Compliance failure. The report includes the physician, patient, account number, discharge date, CPT©4 codes entered, and the failure explanation. Additionally, space is provided for the physician to make comments or identify coding corrections.
ABN Analysis Report A summary listing by physician and date range identifying the number of accounts that have been edited, ABNs produced, ABNs signed, and services received after ABNs were produced.
Failed Procedures Report A listing by physician and date range of the CPT©4 codes that did not pass edits. This report includes the LMRP/NCD, percentage, and actual number of times that the procedure did not pass.
Registration Analysis Report A listing that identifies differences between the codes currently stored for the account, and those that were included when Medical Necessity was checked during the admissions process.
Compliance Verification Log A log of verification results is kept to provide an online inquiry function. This function allows you to determine what values were used to complete the verification, the results, and if an ABN was printed.
Failed Accounts Notification You may review an on-line listing of accounts that have not passed LMRP edits. This listing may include user defined aging categories, such as "in house accounts", "suspense accounts", etc. Request our Free "Denial Analysis Report". It will identify procedures (and their cost) that you have already provided that may not be "Medically Necessary" based upon the NCDs and your Fiscal Intermediary's LMRPs.
Free Report: Request our Free "Denial Analysis Report". It will identify procedures (and their cost) that you have already provided that may not be "Medically Necessary" based upon the NCDs and your Fiscal Intermediary's LMRPs.
Ask about our 30-day NO OBLIGATION, full install trial of the Premier Medical Necessity Compliance Verification software application.
Visit our Products section and see the many other products and services we can offer your hospital.
See why clients like Adventist Health, Asante Health and Banner Health of Colorado use our products.
All Premier Products are iSeries applications. Moving data to and from the iSeries platform is what we do best.
Call us at (801) 299-8772 ext. 118.
Download Premier Solution for Medical Necessity. (pdf - 1,472 KB) |