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Medical Necessity Checking

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Last Post by bruins1986 10 years ago

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bruins1986

(@bruins1986)

Posts: 233

Reputable Member

Topic starter

Hi All,

Has anyone ever tried to set up medical necessity checking in the EMR? We are on EMR 9.8.6 and there is nothing I can see so I assume it would have to be a third party solution if it were ever done; I just wanted to see if anyone has ever tried/would even know who to contact about this.

I don't think we will actually bring this into Live (our Doctor's would show up at our office with pitch forks) but I am interested as one of our Labs has asked if this is possible.

Thanks,
Mike

Posted : November 18, 2014 11:07 am

Dan Karn

(@karnfamily)

Posts: 37

Trusted Member

We have a bidirectional interface with Liaison Healthcare with our labs. They provide the medical necessity checking for us. This, of course, only helps with labs and not internal studies (EKGs etc).

As far as the Doctor's not liking this, it is a required aspect of lab ordering. If this is not done and taken care of, the lab and/or the ordering practice has to foot the bill of uncovered orders.

Dan

Posted : November 18, 2014 12:05 pm

sborchardt

(@sborchardt)

Posts: 218

Reputable Member

We also use Liaison to do our ABN checking of labs. We are multi-specialty and have our scheduling staff review the orders before they are sent to the lab. With the Liaison order it will be written in red, ABN required. We have trained our staff, if they see this to ask the physician for any other dx and redo the medical necessity checking.

Steph B.

Posted : November 20, 2014 9:12 am

bruins1986

(@bruins1986)

Posts: 233

Reputable Member

Topic starter

I appreciate the feedback, thank you both. I do understand that it is a "requirement" of lab ordering but, without getting into details, any issues did not impact our providers or their patients. We are in the early stages of a lab interface and part of this may be working medical necessity checking into the system. I will be running as far in the other direction as possible from that project, thank you very much.

Mike

Posted : November 25, 2014 10:57 am

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