Medical Necessity Field

NextGen® Therapy Suite Help 30.3.13.0

Medical Necessity

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 Config system template. If required, the field title is red until it contains an entry. Medical Necessity field Document Medical Necessity Parent topic: Speech Assessment Panel

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® Adaptive Content Engine Help Enterprise 8.3.1

Medical Necessity Verification for Orders

You can enable an automated process for verifying medical necessity for a practice. To use the system Medical Necessity verification function, you must select Enable Medical Necessity in the Orders/Plans section of the Practice Configuration practice template, and then enter a state or region from the State/Region field. To run the Medical Necessity check for a patient, you must document the insurance details and region in the patient’s demographics information. For more information about the Medical Necessity practice configuration, go to NextGen Healthcare Success Community, and download the Practice Configuration Template User Guide for NextGen® Adaptive Content Engine. orders plans If you select Enable Medical Necessity on the Practice Configuration practice template, the Medical Necessity text field and ABN button appear on the My Plan, My Custom Plan, Labs, Diagnostic Studies, Office Procedures, and Associate Multiple Diagnoses to Orders templates. Based on this medical necessity

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Orders and Plans

The Orders/Plans section allows you to turn on different configuration options related to Orders and Plans including Medical Necessity, My plan, MRI/MRA Questions Required, My Plan, Order Processing, Order Edit Framework, Ortho Orders, Office Diagnosis, AUC and so on. The Orders/Plans section allows you to configure the following: Medical Necessity - If you select the Enable Medical Necessity checkbox, the medical necessity verification process turns on. During the process, the medical necessity check is activated, and the fields required to use the medical necessity feature while placing the orders also appear. The medical necessity fields appear on the My Plan, My Custom Plan, Labs, Diagnostic, and Office Procedures templates. Note: The Medical Necessity application must be licensed and installed to perform the medical necessity check in runtime. The Medical Necessity application is useful to determine if procedures will be covered as medically necessary. My Plan Template MRI/MRA Que

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

Medical Necessity Field

Recommendations

Medical Necessity

MCR Clinical Impression

Document Medical Necessity

Medical Necessity Verification for Orders

Orders and Plans

Example

Medical Necessity Field

Medical Necessity

MCR Clinical Impression

Document Medical Necessity

Medical Necessity Verification for Orders

Orders and Plans

Example