Medical Necessity

NextGen® Therapy Suite Help 30.3.13.0

Medical Necessity Field

The Medical Necessity field can be configured to be hidden, visible (not required), or required on Eval and Progress visit types for those financial classes/payers designated in the configuration in the System Configuration system template. If required, the field title is red until it contains an entry. Medical Necessity field Document Medical Necessity Parent topic: Assessment Panel

NextGen® Therapy Suite Help 30.3.13.0

Document Medical Necessity

Select the Clinical Impressions button. The Medicare Clinical Impressions template opens. Note: If this is a returning patient, you can use Get Data to fill in this template. For more information, see Use Get Data. AINF SLP Med Clncl Impr template for Medicare Clinical Impressions entry Select all checkboxes that apply. The top three checkboxes provide leading sentences for the documentation. Select Save & Close. Your selections in the Medicare Clinical Impressions template are concatenated in the Medical Necessity field. Parent topic: Medical Necessity

NextGen® Therapy Suite Help 30.3.13.0

MCR Clinical Impression

Determine if the financial category selected will be able to require/view/hide the Medicare Clinical Impression that is shown on Single Visit as Medical Necessity. This field is required on Medicare patients with an Eval or Progress Visit. Required and on an eval visit type or checked the re-eval charge checkbox, the med necessity field is red. The label will be red on visits that this is required on, and it is a hard stop on Fee Sheet. If the financial class is set to Required, the therapist will not be able to submit charges on an eval or progress visit type without completing documentation in the Medical Necessity field. Not Required – Show makes the field visible on Single Visit on an Eval or Progress visit type, but it will not be a hard stop on Fee Sheet if they choose to not fill it out. Not Required – Hide hides the field so it is not viewable to users. No POC on Re-eval: If you have any payers that do not require a POC to be sent with a Re-eval, you can use this setting to tur

NextGen® Therapy Suite Help 30.3.13.0

Document Medical Necessity

Select Clinical Impressions. The Medicare Clinical Impressions template opens. Medicare Clinical Impressions template The top three checkboxes provide leading sentences for the documentation. Selecting No changes satisfies documentation if there has been no change in the medical necessity for treatment since the patient’s last visit. Note: To fill in the Medicare Clinical Impressions template, you can use Get Data to pull information from a prior visit. See Use Get Data Select all checkboxes that apply. Select Save & Close. Your selections in the Medicare Clinical Impressions template are converted to prose in the Medical Necessity field. Clinical impressions converted to full sentences in the Medical Necessity field Parent topic: Medical Necessity Field

NextGen® Therapy Suite Help 30.3.13.0

Example

The following image shows settings where the default (*) is not to require the Skill and To Gain fields be filled out, unless the payer is in the Medicare financial class, in which case, the fields are required. Treatment Skill/Gain (Intent) set with defaults of to not required fields unless Medicare is the financial class Parent topic: Configure Skill and To Gain Fields

NextGen® Therapy Suite Help 30.3.13.0

Select CPT Codes

You can select the specific CPT codes to bill out. For each code you can document the Medical Necessity associated with it. Select the checkbox next to the desired codes. To add a modifier, select a modifier (Mod#) field, and then select the modifier from the picklist. Select the Medical Necessity field. A picklist opens with all the treating diagnoses added to this visit. Ainf Aud Diag Treat PL picklist Select a treating diagnosis or select Free Text to type in the medical necessity. Note: In any template that has a Medical Necessity field, if no treating diagnosis has been added, you can add one. Select the Add Treating Dx button at the top right, or if using IMO, select the Problem IT Plus button to open IMO. Any diagnosis added from these templates is also added into the Treating Diagnosis grid in the Assessment panel. Parent topic: Hearing Eval Template

Medical Necessity

Recommendations

Medical Necessity Field

Document Medical Necessity

MCR Clinical Impression

Document Medical Necessity

Example

Select CPT Codes

Medical Necessity Field

Document Medical Necessity

MCR Clinical Impression

Document Medical Necessity

Example

Select CPT Codes