Medicare Medical Necessity

Today’s outpatient Medicare payment system is complex and it is changing rapidly. Each year, an increasing number of services that were once paid individually are now packaged into one payment. This unpredictable payment logic leads to larger outpatient denials because packaging places a premium on key procedures. There are no HIS based solutions that can provide this logic while checking Medical Necessity.

Prospective Payment System Medical Necessity

Our solution prevents real denials because it is designed for how Medicare pays today. Our Medicare experts integrated the outpatient payment system into its design so that your staff: