When it comes to reimbursement for services, preparing and submitting claims to Medicare is perhaps the single biggest risk area for hospitals. All Medicare claims and supporting documentation must be complete and accurate and must reflect reasonable and necessary services ordered by a licensed medical professional. It’s imperative that you use consistent and appropriately documented guidelines in connection with claims submission, and maintain all relevant records.
The Solution
CareMedic, a leader in real-time compliance checking, facilitates compliance across the continuum of care through VerifyAR Compliance Checking. The solution plays an integral role in your efforts to promote compliance and to detect and resolve billing information that does not conform to regulations. A browser-based solution hosted by CareMedic, VerifyAR Compliance Checking provides accurate and timely outpatient medical necessity compliance checks prior to services being rendered and at point-of-access areas in hospitals, as well as applying Correct Coding Initiative (CCI) and Outpatient Code Editor (OCE) edits. The system automatically produces and stores Advanced Beneficiary Notices (ABNs), supporting clear and correct communication with patients regarding financial expectations prior to treatment.
Benefits:
- Improves patient satisfaction by clarifying the patient’s rights and obligations prior to service
- Reduces bad debt, days in AR and potential fines for billing non-covered services to Medicare
- Stores electronic patient and physician signatures on ABNs and requisitions, available on demand to the appropriate users
- Improves Medicare compliance and reduces the risk of fines
- Moves service line charges to non-covered charges if the claim does not have the appropriate occurrence/condition codes, automatically reducing manual intervention
- Generates both single and multiple facility reports
- Includes enhanced conditional links to allow customers to create and link to their own medical necessity documentation.
- Automatically generates ABNs (general, laboratory or combined) in multiple languages for non-compliant procedures, including English, French, Russian, Bosnian and Spanish
- Improves compliance and reimbursement with regular updates to CCI and OCE edits (i.e., frequency, age and sex), LCD data, National Coverage Determinations (NCDs), modifiers, and codes
- Eliminates the difficult task of manually gathering LCD data and staying current with changes in local and national coding and regulations
- Reduces denied charges that will never be paid
- Users can easily manage procedure codes with multiple associated policies
- National Provider Identifier (NPI) ready
Compliance Checking can be easily integrated into your scheduling, registration, medical records system or order entry systems, and is customized to enable your organization to deal with complex Medicare regulations while supporting your institution’s workflow.
Compliance Checking customers using AccelerateAR MedicareRT enjoy the added benefit of a final medical necessity check prior to claim submission, using the same medical necessity content to assure proper coding based on procedure and compliance rules. This final check protects your organization when changes are made to the diagnosis after a compliant procedure is performed, or when procedures are not checked prior to care. In addition, when Compliance Checking is used in conjunction with MedicareRT, ABNs are automatically linked with the appropriate post-service claims to eliminate manual ABN matching.
CareMedic’s end-to-end compliance solution helps ensure that you will always have a team of experts supporting you to help make sure you get the reimbursement you deserve.
For more information, contact us via the Web or call us at 1-800-508-8494.
