Before you begin
- Ensure that you have the required license for Medical Necessity check.
- Ensure that you have configured medical necessity check in File Maintenance.
- Ensure that you have selected the insurance information for the patient in the All tab.
Note: Computerized Physician Order Entry (CPOE) derives the insurance settings from the Practice Preferences configurations. 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.
For a test that does not meet the medical necessity criteria for insurance reimbursement, the patient can consent to financial responsibility by signing the Advance Beneficiary Notice (ABN). You can print the ABN for the patient to read and sign and record the patient's ABN status.
- Open CPOE.
- Select an order item.
- Assign a diagnosis to the selected order item.
- Select the Laboratory or Diagnostic tab and check if the order item has a failed Check Medical Necessity for Laboratory and Diagnostic Order Items status.
- To document the patient's payment choice, select ABN Options and select one of the following:
- Patient asks to bill payer
- Patient to pay for service
- ABN has not been signed
- Select Print/Preview ABN.
The
Select Medical Necessity Failure Reason window opens.
- Select the medical necessity failure reason and select Print ABN.
Note: The ABN report complies with the Centers for Medicare and Medicaid Services (CMS) regulations. For more information, download the latest Reports User Guide for NextGen® Enterprise EHR.
