Medical Necessity

Understanding medical necessity rules is a critical component of coding and Medicare billing compliance. Ensure that your staff can quickly identify covered services and know when to generate Advanced Beneficiary Notices (ABNs) with the MediRegs Medical Necessity resources. Quick and easy access to weekly updates for LCDs, NCDs, and contractor bulletins provide effective validation of the medical necessity of ordered procedures and services.

Our Medical Necessity resources include a separate collection of local coverage determinations (LCDs) for each contractor/setting combination, with comprehensive archives.

Each collection contains:

• An index of currently active and open draft LCDs.
• Subfolders containing active, draft and archived LCD.
• National Coverage Determinations include laboratory coding policy manual instructions, archives, and related articles.
• Pages can be customized to ensure coders automatic receive email alerts and can easily search the subset of contractors and/or states relevant to them.

Benefits

• Increases the speed of code validation
• Improves the accuracy of initial coding
• Expands the ability to research claims denials
• Demystifies complex coverage rules with easy coding crosswalks and related information.
• Web-based = always on
• Automatically updated; no need to re-order, wait for the mail, or install updates
• Integrated with related information: One-click access from Code Explorer and to HCPCS & CPT CodeBook for payment and coding guidelines.
• Easy to use; browse anb search coverage information from a single location
• Simple sortable index for each contractor.
• Stay up-to-date with E-mail alerts that can be customized to your favorite search terms.
• Includes drafts and archives.
• User can customize for instant search of select contractor and national resources.

Features

• Weekly updates with Automatic email alerts
• Complete index of active Local and National coverage determinations
• Coding crosswalk section for HCPCS, Revenue Codes, ICD-9-CM Diagnosis codes, etc., with direct links to related coding and payment rules for codes
• Integrated with related information critical for medical necessity evaluation, including National Coverage Determinations, NCD Coding Manual, and coverage analyses, Medicare Contractor Bulletins, and CMS benefit, claims and coverage policy documentation
• Customized state or Medicare Administrative Contractor-specific search
• Access to logic for all Medicare Administrative Contractors, including bulletins and archived LCDs & NCDs
• Instant access to electronic Advanced Beneficiary Notice forms and instructions
• Comprehensive Archives and drafts open for comment

Data Source

• Center for Medicare & Medicaid Services (CMS) Medicare Coverage Database
• All Medicare Administrative Contractor (MAC), Fiscal Intermediary (FI) and Carrier web-based newsletters and bulletins.

MediRegs Related Tools

• HCPCS & CPT® Code Set
• ICD-9-CM Code Set
• CMS Manuals
• Code Explorer

Purchase an affordable, single user set of MediRegs Medical Necessity resources through the basic Coder’s Resource Center.

• To receive additional regulatory information, upgrade to one of our other suite products (Code & Revenue Resource Center, Audit & Revenue Resource Center or Regulation & Reimbursement Suite). 

For multiple-user pricing, or a free trial, contact a MediRegs sales representative.