Features & Benefits:

• With the MedicalNecessityPro.com you’ll validate the medical necessity of ordered outpatient procedures and services even faster. Quickly and reliably determine if treatments will be covered before rendering services.
• Medicare localities and pinpointed counties within localities. Simplify your GPCI adjusted calculations.
• Check Whether an Order Is Medically Necessary According to CMS NCD and LCD Rules to Help Reduce Write Offs. The medical necessity compliance tool determines whether a supportive diagnosis has been provided for the planned procedure or service and also performs edit checks for NCCI, CPT® and ICD-9-CM validity, age/sex, frequency edits, inpatient-only procedures under OPPS and other statutorily excluded items and services or diagnoses.
• Make Sure the ABN Form Is Completely and Accurately Filled Out. Use the ABN generation tool to generate a pre-populated ABN if an item or service is not covered and to confirm coverage policy details with the patient.
• A Robust Keyword, Acronym and Code Search Logic Will Expedite the Registration Process and Will Help You Avoid the Cost of Placing Coders in Patient Access Areas. Code detail information provides lay descriptions, spell-check and acronym translations so staff can easily convert descriptive procedures and diagnoses into CPT® and ICD-9-CM codes.
• Complete and Reliable Database of Local and National Coverage Policies. Search by keyword, Medicare contractor, LCD ID number, HCPCS Level II code, CPT® code or ICD-9-CM code to quickly identify ICD-9-CM codes that support medical necessity.
• Complete Listing of Diagnosis Codes. Lists all valid ICD-9-CM codes that support medical necessity, with code descriptions and fourth and fifth digits, where required.
• Additional Code Linkage Information. Search through our claims database of ICD-9-CM and CPT® code links—if your FI or carrier doesn’t have the medical necessity guidelines and coding information you need, see the carriers and FIs that do.
• CPT® is a registered trademark of the American Medical Association.