Set Up Medical Necessity to Run Automatically

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

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: Medical Necessity Setup

NextGen® Enterprise EHR Help

Set Up Medical Necessity Other than Medicare for Payers

Starting with Version 5.8, you can run the NextGen® Medical Necessity Check for payers other than Medicare. These payers, however, must follow the Medicare guidelines. You must set up each payer individually. Open File Maintenance. Select System > Payer. Select your payer, and select Open Menu to access your payer. Select the Order Module tab. To indicate that the NextGen® Medical Necessity Check should be run for this payer, select Follows Medicare rules for Medical Necessity Checking. To access an ABN report, select the folder and then select the ABN report path or you can enter the ABN report path, and select the ABN Crystal Report. Note: The Advanced Beneficiary Notice (ABN) report has been updated to be in compliance with the Centers for Medicare and Medicaid Services (CMS) regulations. For more information, download the latest Reports User Guide forNextGen®Enterprise EHR. Select OK. Parent topic: Medical Necessity Setup

File Maintenance Help for NextGen® Enterprise 8

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: Orders Module Practice Preferences Setup

NextGen® Enterprise EHR Help

Medical Necessity Setup

You must set up the NextGen® Medical Necessity Check to determine if Medicare will pay for a test when selecting a diagnosis for an order and run it when you place a test order. If Medicare or other insurance does not cover the costs of the test, you can print an Advanced Beneficiary Notice (ABN) and record the patients' decision about how to handle test codes. If an order does not contain Medicare or other insurance then you can't run NextGen® Medical Necessity Check as this follows the Medicare guidelines. Note: You need to obtain a license to run NextGen® Medical Necessity Check. To set up the NextGen® Medical Necessity Check locations, do the following: Access and download the NextGen® Medical Necessity Check update package from the NextGen Healthcare Success Community. This package populates the Locations (and associated data) in the Orders Module tab. Set up the appropriate NextGen® Medical Necessity Check encounter level insurance for the appropriate location. For more informati

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

Set Up Medical Necessity to Run Automatically

Recommendations

Set Up the Medical Necessity Location

Skip the Medical Necessity Check if Test has no CPT4 Code

Set Up Medical Necessity Other than Medicare for Payers

Set Up Medical Necessity to Run Automatically

Medical Necessity Setup

Configure Medical Necessity Check for Laboratory and Diagnostic Order Items

Set Up the Medical Necessity Location

Skip the Medical Necessity Check if Test has no CPT4 Code

Set Up Medical Necessity Other than Medicare for Payers

Set Up Medical Necessity to Run Automatically

Medical Necessity Setup

Configure Medical Necessity Check for Laboratory and Diagnostic Order Items