Medical Necessity Compliance

CHALLENGE — Evaluating Medical Necessity BEFORE Services are Provided
CHALLENGE — Confirming Medical Necessity Evaluation AFTER Services are Provided

CHALLENGE— Evaluating Medical Necessity Before Services are Provided
SOLUTION— Medical Necessity Ordermate (MNO)

Medical Necessity Ordermate (MNO) is a pre-service medical necessity evaluation tool that helps staff who are not trained coders quickly and easily convert narrative procedures and diagnoses into CPT and ICD-9 codes.

MNO is completely integrated with the MEDITECH HCIS, and staff can perform the evaluation wherever a customer defined screen (CDS) exists - in the LAB Enter/Edit Requisition routine, etc. The evaluation tool can be used by staff in any area of the hospital - patient scheduling, registration, and ancillary departments, and information entered into MNO in other areas can be easily accessed by laboratory staff.

CMS Lab and General formats of the Advanced Beneficiary Notice (ABN) in English, Spanish and a third language selected by the hospital are provided with every purchase of MNO. Once an ABN status (signed, refused, etc.) is entered into the system, it can be viewed across the Meditech network by users with the appropriate access, including staff in the business office.

Find out more about MNO:

CHALLENGE— Confirming Medical Necessity After Services are Provided
SOLUTION— Medical Necessity Checkmate (MNC)

Because tests are often added while services are being provided to patients, and because insurance information can sometimes be changed during the patient accounting process, it is important to confirm medical necessity of procedures after services are provided so that claims are not rejected.

Medical Necessity Checkmate (MNC) is a post-service medical necessity software system that re-evaluates medical necessity just before a claim is dropped. MNC identifies non-covered charges with no ABN on file and prevents these accounts from being prorated. MNC can also automatically move appropriate non-covered charges to the Self-Pay bucket and add occurrence codes, dates and other items such modifiers, saving patient accounts staff valuable time.

Find out more about MNC: