Set Up Medical Necessity to Run Automatically

File Maintenance Help for NextGen® Enterprise 8

Skip the Medical Necessity Check if Test has no CPT4 Code

You can set up NextGen® Medical Necessity Check to skip those tests that do not have a CPT4 code assigned. NextGen® Medical Necessity Check will check tests with CPT4 codes and will not produce errors if a test with no CPT4 code is found. Select File Maintenance > System > Practices. Select the list or enter your location name and select Open Menu to open your practice. Select Preferences. In the Practice Preferences window, select Order module > Lab/Rad tab. To indicate that the Medical Necessity Check should not run when a test does not contain a CPT4 code, select Skip Medical Necessity Check if no CPT4 code. Select OK to save this preference. Select OK to exit the Modify Practice Information window. Parent topic: Orders Module Practice Preferences Setup

NextGen® Enterprise EHR Help

Set Up Medical Necessity to Run Automatically

You can choose to set up NextGen® Medical Necessity Check to run automatically when you save an order. Select File Maintenance > System > Practices. Select the list or enter your location name and select Open Menu to open your practice. Select Preferences. In the Practice Preferences window, select Order Module > Lab/Rad tab. To automatically run the NextGen® Medical Necessity Check when you save an order, select Run Medical Necessity Check when order is saved. Select OK to save this preference. Select OK to exit the Modify Practice Information window. Parent topic: Medical Necessity Setup

NextGen® Enterprise EHR Help

Configure Medical Necessity Check for Laboratory and Diagnostic Order Items

In File Maintenance, you can configure the settings for Computerized Physician Order Entry (CPOE) to automatically run Medical Necessity Check when you select a laboratory or diagnostic order item. Note: For more information on Practice Preferences in File Maintenance, go to NextGen Healthcare Success Community and download the latest File Maintenance Preferences Guide for NextGen® Enterprise. Open File Maintenance. Under Master Files, select EHR, and then select Practices.The Practices List window opens. Double-click a practice name.The Modify Practice Information window opens. Select Preferences.The Practice Preferences window opens. Under Preference List, select Orders Module, and then select the Lab/Rad tab. To automatically run the Medical Necessity Check when you select a laboratory or diagnostic order item, select Run Medical Necessity Check when order is saved. Select OK. Parent topic: CPOE Configuration Requirements

NextGen® Enterprise EHR Help

Set Up the Medical Necessity Location

The Location field in the NextGen® Medical Necessity Check setup is not a practice location, it is a location for Medical Necessity related to Medicare coverage. Open File Maintenance and select System > Locations. Select the list or enter your location name, and then select Open Menu to open your location. Select Order module tab. In the Medical Necessity section, select B from the Part A or Part B list and the Location, for example Pennsylvania. Note: The NextGen® Medical Necessity Check only runs against those orders that have Medicare Part B associated with them. Select OK to save these values for the selected practice. Parent topic: Medical Necessity Setup

NextGen® Enterprise EHR Help

Checking Medical Necessity for a Test

To determine if Medicare or another insurance (which follows Medicare guidelines) covers the cost of a test, you can run the NextGen® Medical Necessity Check. You can set up the Medical Necessity Check in File Maintenance to run automatically when you save an order or you can run it manually. Note: To use the NextGen® Medical Necessity Check when selecting tests, you must first set it up in File Maintenance. For more information about setting up Medical Necessity, go to the NextGen Healthcare Success Community and download the Orders Module Setup Guide for NextGen® Enterprise. To run it manually, select the Check Medical Necessity in the Assign Diagnosis to Selected Tests panel. Obtain the ABN Report and Verify Cost Coverage When a NextGen Medical Necessity Check Fail Parent topic: Assign Diagnosis to Selected Tests Panel

NextGen® Enterprise EHR Help

Set Up Orders Module Practice Preferences

Open File Maintenance and select System > Practices. Double-click a pratice. In the Modify Practice Information window, select Preferences and then select the Orders Module. There are several check boxes to set preferences for printing, the use of the NextGen Compendium, and other settings. There are additional preferences associated with the Orders module that can be set for your practice. Parent topic: Medical Necessity and Orders Practice Preferences Setup Related reference Order Module Practice Preferences

Set Up Medical Necessity to Run Automatically

Recommendations

Skip the Medical Necessity Check if Test has no CPT4 Code

Set Up Medical Necessity to Run Automatically

Configure Medical Necessity Check for Laboratory and Diagnostic Order Items

Set Up the Medical Necessity Location

Checking Medical Necessity for a Test

Set Up Orders Module Practice Preferences

Skip the Medical Necessity Check if Test has no CPT4 Code

Set Up Medical Necessity to Run Automatically

Configure Medical Necessity Check for Laboratory and Diagnostic Order Items

Set Up the Medical Necessity Location

Checking Medical Necessity for a Test

Set Up Orders Module Practice Preferences