Create Your Own Medical Necessity Quick Reference Tool

If you want to keep denials and compliance problems at bay, your claims must support medical necessity.

So retrofit your own, customized medical necessity quick power-reference tool with these tips from Sandy Nicholson, who taught some classes at the recent E/M Coding & Billing Conference in Orlando.

Step 1: Identify services which you provide for which CMS has established an NCD (National Coverage Determination) or LCD (Local Coverage Determination).

Step 2: Identify diagnoses and corresponding ICD-9 code or code range.

Step 3: Create spreadsheet to allow identification of service and corresponding diagnosis/code.

Sandy shared a few lines of how such a spreadsheet might look, as an example …

Don’t forget: The documentation and coding may not support medical necessity, which is why your practice should have Medicare benes sign an Advance Beneficiary Notice (ABN) of Non-Coverage CMS-R-131. For the form that CMS has required since March 1, 2009, go here, Nicholson reminded conference attendees.

Don’t miss our 2010 Billing & Collections Update, plus tons of tips to boost your practice’s bottom line. Coming this December to Orlando!

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