• 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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