13 Questions Hospitals Should Ask About ICD-10 and Medical Necessity

To ensure hospitals are ready to verify medical necessity issues in the future ICD-10 habitat, hospitals should ask medical necessity software vendors the following 13 questions, according to a Craneware blog post.

•    Are local coverage determination/medical necessity requirements maintained for every contractor, including all Medicare Administrative Contractors, fiscal intermediaries and commercial payors?

•    Do the LCDs contain not only CPT to ICD-9 verification, but also check for frequency, gender and age criteria as well as primary and secondary diagnosis coding?

•    Is coding available for LCDs that have a probability for future Recovery Auditor (RAC) medical necessity audits?

•    Are qualified individuals reading and interpreting difficult LCDs to ensure accurate results?

•    Are prior authorization warnings available for all payors?

•    Are proprietary edits available?

•    Are there customizable keyword sets to support users with limited coding experience?

•    Is medical necessity for Medicaid provided?

•    Are CMS and MAC/FI/carrier websites monitored weekly to keep every policy updated?

•    Is direct access provided to current policies to validate services?

•    Are advance beneficiary notices or notices of non-coverage issued before providing services that do not meet "medical necessity" guidelines?

•    Is there a review of payor medical necessity denials to create front-end warnings?

•    What preparations has the vendor made for the ICD-10 transition?

More Articles on ICD-10:

On the Coding Radar: 3 Reasons Why Hospital CEOs Must Pay Attention to ICD-10

14 ICD-10 Questions Hospitals Should Ask Software Vendors

ICD-10 or ICD-11? The Dilemma Behind Both Coding Systems

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