You provided care and completed all the tedious admin work to get paid. Denied! Complying with medical necessity requirements is, well, a requirement if you want to get paid. Unfortunately, you likely suffer from managing many moving parts among many stakeholders only to see your claims languish, trapped in the mud that is denial management.
Protect Your Revenue
Avoid the mud by proactively integrating best practice tasks and software within your clinical and business workflows. Do it right the first time. Get paid the first time.
Make medical necessity compliance easier with a live feed of the latest compliance-related codes, rules, and other data. Test your compliance internally before claim submission. Reduce the probability of compliance misses by going digital with electronic signature and document storage for ABNs.
FirstComply… Get paid right, the first time.
Your “Front-End” Solution for Medicare Compliance
Ensure Medicare compliance and check any procedure against a diagnosis according to Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) on the “front-end” using FirstComply.
Get full access to all the data needed to accurately verify and analyze medical necessity criteria.
Available data elements include:
- Procedure codes (CPTs)
- Covered diagnosis codes (ICDs)
- Noncovered CPT and ICD codes
- Frequency limitations
- Policies (LCDs, NCDs, and DME policies published by the Centers for Medicare and Medicaid Services)
- Commentary on rule changes provided with every update
- Rules Analyzer for in-depth research
Our software assists with Medicare medical necessity checks so that an advanced beneficiary notice (ABN) can be produced to protect facility revenue for those encounters that fail to meet medical necessity requirements.
Select appropriate procedure (CPT) and diagnosis (ICD) codes easily via keyword search, order screens, and other proprietary search methodologies. This medical necessity software streamlines the entire Medicare compliance process for use in areas like:
- Central scheduling
- Lab work
- Patient accounting
- Health information management
- Physician offices
- Infusion centers
What’s at Stake?
When exploring options for medical necessity checking software, it’s important to consider the risks of lost revenues and the problems posed by non-compliance. Medicare restricts the reimbursement of certain outpatient services based on medical necessity criteria published in NCDs and/or LCDs.
- On a national level, CMS publishes NCDs. On the local level, LCDs and DME policies are published by Medicare Administrative Contractors (MACs). If claims for these procedures are submitted with diagnosis codes that do not support medical necessity according to a NCD, LCD, or DME policy, the claim is denied for payment.
- Furthermore, unless a patient signs an ABN prior to receiving the service, the provider may not bill the patient for these services. The facility is therefore left without an option to collect for the costly healthcare services that it has already rendered.
- The only solution is to catch these procedures before they are performed, check for compliance with the NCD/LCD/DME policy, and secure an ABN from the patient for procedures that don’t pass the medical necessity test.
This last point is why our medical necessity compliance software is so essential to healthcare providers – because it allows them to ensure all proposed procedures meet Medicare stipulations.
Our software for Medicare compliance offers a host of worthwhile attributes which will make your facility’s administrative operations run more smoothly and efficiently, ensuring that you are meeting all compliance stipulations.
Let’s take a look at everything FirstComply can do for your business.
One robust feature of FirstComply is that it tracks pass/fail results by any number of criteria chosen by the user, including, but not limited to:
- Date of service
- Ordering physician
Additionally, educational materials can be produced for frequently failed procedures to ensure medical necessity compliance in the future.
FirstComply is a secure, browser-enabled software package, allowing your IT department to focus on other efforts.
Electronic Signature Capture to Help You Go Paperless
Why pass more paper around your office? With FirstComply’s optional electronic signature capture module, ABNs and other documents are stored electronically. FirstComply also has the ability to “push” documents stored within the system into 3rd party electronic imaging software.
Interface with Client Systems
With FirstComply, interfaces are developed for clients within:
- Central scheduling
- Patient accounting
- Various other systems
Although FirstComply interfaces are HL7 compliant, custom made solutions are regularly produced to meet the full system integration needs of the healthcare continuum.
Auto Updating of LCD, NCD, and DME Rules
As new LCD/NCD/DME updates are published, MediQuant updates FirstComply clients using remote access. The updates are implemented by MediQuant, resulting in a seamless process for clients.
As you can see, by using FirstComply medical necessity checking software you’ll be working with a product ideal for your administrative needs.