Medical Necessity Training Toolkit

Don’t leave your hard-earned money on the table!

The incessant challenge of determining medical necessity is even greater today than it has been in past years. A key change to the medical necessity process is the new advanced beneficiary notice (ABN) and instructions that takes effect on March 1, 2009. Adding a sense of urgency, a Recovery Audit Contractor (RAC) program will be rolled out in new states this year, and that’s going to cost providers millions. ABN and hospital issued notice of noncoverage (HINN) forms are your gateway to proper coverage and reimbursement. Now is the time to educate your team so your hospital doesn’t lose revenue by having to refund Medicare over incorrect claims.

Ensure your team gets it right the first time.

The Medical Necessity Training Toolkit is loaded with user-friendly, customizable tools you can use to train your entire staff.

The CD-ROM contains:

• An interactive “Jeopardy”-style game
• ABN and HINN quizzes to test compliance understanding
• A PowerPoint presentation that clearly explains the revised outpatient ABN and inpatient HINNs
• Training scripts and checklists for new and veteran staff members
• Sample policies and procedures facilities can use to create their own
• An ABN audit tool
• CMS links and resources

With this training resource, your staff will be prepared to:

• Recognize the importance of ABN and HINN
• Understand the effective and compliant delivery of these forms to the patient
• Explain the reasons for either the ABN or HINN when the patient asks
• Identify the information needed from physicians to determine medical necessity and communicate to physicians the importance of their cooperation to avoid denials
• Understand the revenue and RAC implications of medical necessity compliance
• Recognize when certain condition codes and modifiers apply

Who should purchase this CD-ROM?

Patient registration/access, patient financial services (PFS), reimbursement/revenue cycle, corporate compliance, case management, health information management, emergency department, rehabilitation services, laboratory services, and radiology.

JEOPARDY!^® is a registered trademark of Jeopardy Productions, Inc., of Culver City, CA. The Medical Necessity Training Toolkit game on this CD-ROM is not endorsed by Jeopardy Productions, Inc., nor is it affiliated with Jeopardy Productions, Inc.

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