Compliance Checking

Medical necessity checking is quick and convenient with single keystroke execution.

If you're looking for a simple and effective way to check medical necessity and ensure that your facility will be fairly reimbursed for the services you provide, RCM's Compliance module is a fast and convenient solution. This solution provides Medical Necessity Checking during Lab order entry. This software tool enables you to print an Advanced Beneficiary Notice (ABN) form for the patient's signature for tests that don't pass medical necessity checking.

RCM's Compliance module automatically matches allowed diagnosis codes (per LCD/NCD) to each ordered test for up to 20 diagnosis codes. When all ordered diagnosis codes are entered, medical necessity checking is executed with just one keystroke. If no matches can be made, a message is displayed to the user, and the user may print an ABN at this time for the patient's signature.

Automatic checking of allowed diagnosis codes, ABN, and GA modifier capabilities increase laboratory revenue by reducing denials and allowing your facility to capture revenue that might otherwise be lost by enabling you to bill patients for denied tests for which you have obtained signed ABNs.

Compliance module provides:

• Medical necessity checking and diagnosis assignment according to LCD and NCD rules
• Automatic printing of ABNs when necessary
• Accommodates multiple region capability encompassing multiple laboratory location
• Simple and cost effective installation