medical necessity criteria, medical necessity documentation, medical necessity guidelines, medical necessity files

Properly demonstrate medical necessity…get paid. Unfortunately the rules for demonstrating medical necessity are dependent in large part on the clear understanding and application of a live, ever-changing enigma of data and information. Attempt to access and curate this content at your own peril. You’ll be trapped in the mud, managing denied claims.

Avoid the mud by proactively integrating your clinical and business workflows. Do it right the first time. Get paid the first time.

What to Expect...

AccuRules medical necessity documentation and rules sets will provide each of the following:

  • Customized file formats and content to meet your facility’s particular specifications. Epic- and Meditech-ready file formats.

  • Timely updates (continuously to monthly, depending on your preference, which means no waiting for quarterly updates)

  • Advice from MediQuant’s experienced team on how to best utilize the content

These aspects help to make working with your medical necessity files easier and more accurate than ever before, ensuring that your facility operates to its optimal ability.

Working with Essential Medical Necessity Criteria

The AccuRules files contains all the data needed to accurately verify and analyze medical necessity criteria. Available data elements that clients can expect as part of the system include:

  • Procedure codes (CPTs)

  • Covered diagnosis codes (ICDs)

  • Non-covered CPT and ICD codes

  • Frequency limitations

  • Age and gender restrictions

  • Policies (LCDs, NCDs, and DME policies published by the Centers for Medicare and Medicaid Services) delivered to you in HTM or PDF format, or as links

  • Commentary on rule changes provided with every update

  • Access to MediQuant's online Rules Analyzer for in-depth research

Going Beyond Content

MediQuant’s AccuRules offers two modules that can be used in conjunction with your current host system (HIS, billing, order entry, etc.) for a custom medical necessity solution. These modules are:

  • RulesEngineOnline – Your host system feeds us the pertinent procedure and diagnosis information. Accessing AccuRules, we produce a medical necessity criteria result and return it to your host system.

  • ABN Engine – In this iteration, you are able to produce and store an ABN directly from your host system. This module comes complete with electronic signature capture capability and all approved CMS ABN formats (English or Spanish, and Lab or General).

As you can see, the versatility of MediQuant’s AccuRules is one of the reasons it should be your essential resource for medical necessity documentation.

Meeting the Needs of Our Clients

In addition to making timely and accurate updates, MediQuant's AccuRules content includes access to the actual policies used for the rule files—an invaluable tool for your end users in their medical and administrative duties.

AccuRules files are also distributed with a summary of the changes made to the medical necessity rules, which is a key feature that helps users stay in tune with what they need to focus on in their medical necessity compliance process.

Where is AccuRules Being Used?

The MediQuant AccuRules files are utilized in such places as:

  • Hospitals

  • Physician offices

  • Labs

  • Imaging centers

Regular users of our medical necessity criteria rules sets include staff in departments like:

  • Radiology

  • Registration

  • Pre-registration

  • Lab

  • Compliance

  • Scheduling

  • Billing

  • Coding

  • Physician offices

Learn More about AccuRules