MediQuant's FirstComply Medical Necessity Software Reduces Risk Of Lost Revenue And Noncompliance

Streamlines Medicare medical necessity processes for hospitals, physician groups and other healthcare organizations - reduces claim denials; helps prevent need for ABN; increases reimbursement; improves Medicare compliance with the most accurate, customized data

FirstComply from MediQuant is software that provides a front-end solution for hospitals, physician groups and healthcare organizations to prevent lost revenue and noncompliance by checking ordered procedures against Medicare diagnosis restrictions.

Using FirstComply at scheduling and registration helps personnel check procedures against ever changing medical necessity policies. With between 100 and 1,000 revisions posted each week, it is difficult for front-end staff to keep abreast of the most current requirements. Additionally, a front-end solution for validating procedures against diagnosis and frequency restrictions according to local and national coverage determinations is imperative to reduce the risk of lost revenue resulting from claim denials.

For encounters that fail medical necessity requirements, FirstComply automatically generates an Advanced Beneficiary Notice (ABN) for the patient to sign, acknowledging that he or she may be billed for the procedure. It also keeps a record and produces reports to locate areas of improvement and track progress and ROI.

Medicare restricts the reimbursement of certain outpatient services based on medical necessity criteria that is published in a LCD or NCD. If the claims for these procedures are submitted with diagnosis codes that do not support medical necessity according to the LCD or NCD, then Medicare denies the claim for payment. Unless a patient has signed an ABN prior to service, the provider may not bill the patient for these services. The hospital or physician group now has no means to collect reimbursement.

"Coverage errors result in millions of dollars in lost revenue," said Stephanie Solich, Manager of Medical Necessity Content at MediQuant. "Checking for full medical necessity compliance with the LCD or NCD and securing an ABN for procedures that don't pass the medical necessity evaluation is the best way to maximize reimbursement."

FirstComply is available as a web-based service or installed on your hardware. It supports its own rules and updates are made remotely and seamlessly. With FirstComply, selecting appropriate procedure codes and ICD codes is simplified via key word search, order screens and other proprietary search methodologies. The enterprise-wide system streamlines the entire medical necessity process for use in Central Scheduling, Registration, Lab, Radiology, Patient Accounting and Health Information Management (HIM) for hospitals, physician groups and other healthcare organizations. With accurate and proper documentation, claim denials are reduced, the need for an ABN is minimized, medical necessity compliance with the LCD or NCD is improved, and Medicare reimbursement is increased.

To learn more about solving coding compliance challenges, reducing claim denials, preventing the need for an ABN and increasing Medicare reimbursement with FirstComply, visit www.mediquant.com/firstcomply.html.

About MediQuant
In business since 1999, MediQuant develops advanced software solutions that reduce time, cut costs and increase revenue for a wide range of hospitals and healthcare organizations. Extensive healthcare software development, past revenue cycle management, clinical services and data management expertise enables MediQuant to craft unique solutions to common problems encountered by chief financial and information officers, patient accounting and human resource directors, as well as physician practice managers and clinicians. For more information, visit www.mediquant.com.