Obtain the ABN Report and Verify Cost Coverage When a NextGen® Medical Necessity Check Fail

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

Obtain the ABN Report and Verify Cost Coverage When a NextGen® Medical Necessity Check Fail

When you run the medical necessity check for a patient with Medicare or another insurance (which follows Medicare guidelines), if the test fails, a notice displays. A red X is returned when you select Check Medical Necessity for an order. Note: If you receive a Cannot Confirm message, Medicare coverage for the selected tests cannot be determined. This message is not the same as a failure. Run the NextGen® Medical Necessity Check again to confirm coverage. If the NextGen® Medical Necessity Check fails, do the following: In the Select Medical Necessity Failure Reason window, select the reason for the failure. To print an Advanced Beneficiary Notice (ABN) to give to the patient, select Print ABN. The ABN includes the reason for the failure. To preview the ABN before you print it, select Preview ABN. Contact the patient to determine how the patient would like to pay for the services. Document the patient's payment option in the ABN Options section on the Assign Diagnosis to Select Tests pa

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

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

Select ABN Option for Failed Medical Necessity Check

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 ite

NextGen® Enterprise EHR Help

Select ABN Option for Failed Medical Necessity Check

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 ite

Obtain the ABN Report and Verify Cost Coverage When a NextGen® Medical Necessity Check Fail

Recommendations

Checking Medical Necessity for a Test

Obtain the ABN Report and Verify Cost Coverage When a NextGen® Medical Necessity Check Fail

Medical Necessity Setup

Medical Necessity Setup

Select ABN Option for Failed Medical Necessity Check

Select ABN Option for Failed Medical Necessity Check

Obtain the ABN Report and Verify Cost Coverage When a NextGen® Medical Necessity Check Fail

Checking Medical Necessity for a Test

Obtain the ABN Report and Verify Cost Coverage When a NextGen® Medical Necessity Check Fail

Medical Necessity Setup

Medical Necessity Setup

Select ABN Option for Failed Medical Necessity Check

Select ABN Option for Failed Medical Necessity Check