Hi-just wondering what other hospitals are doing as far as Medical Necessity. Specifically, who has incorporated front-end checking, what area of your facility is responsible for medical necessity follow-up, and what area is responsible for the MN dictionary maintenance-HIM, IS? If you use a product to maintain the MN dictionary, what types of software/services are being used.
We are Magic 5.4 about to go to 5.61 and we use Meditech's MN checker. We built and maintain this in-house and find that the checking itself works fine, but there are report discrepancies between modules, there are no reports that will pick up reflexed Lab tests since the system generates the test and medical necessity is never invoked. We also have process breakdowns-Admissions is responsible for updating the dictionary but we feel that it is important that someone with a coding background be responsible for this-so I'm wondering how other facilities feel about this. We do the checking at the point of admission and if there are any issues we print the ABN, notify the doctor's office then expect HIM to continue the follow-up. I'd like to know if this is the typical process or if follow-up immediately goes to HIM? Thanks for any information... Patience Patience Phillips Revenue Cycle Coordinator St. Mary's Hospital at Amsterdam [EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]>
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