What is it?
An integrated software solution that determines if medical procedures meet medical necessity requirements in accordance with both the National Coverage Determination (NCD) rules as well as the Local Coverage Determination (LCD) rules as determined by the following CMS appointed Medicare Carriers and Fiscal Intermediaries:
- National Government Services (NGS) for Medicare Part A
- TrailBlazer Health Enterprises, LLC for Medicare Part A
- Wisconsin Physician Services (WPS) for Medicare Part A & B
Why do I want it?
- Minimize claim denials
- Increase collections and cash flow
- Obtain accurate determination of patient co-pay and deductibles
- Accurately set patient coverage expectations, thereby enhancing overall patient satisfaction and minimizing the risk of uncollected balances
- Reduce patient billing
- Enhance staff productivity by avoiding manual verification
How does it work?
At Point of Registration
eCare® Online Medical Necessity is an Internet-based solution that allows you to choose procedures and diagnosis from customizable lists and evaluate them against local and national Medical Necessity rules. If a procedure does not pass, an ABN can be generated.
At Point of Order Entry
For Hospital Information Systems that have Medical Necessity checking built into Order Entry, Nebo offers monthly data files at a fraction of the cost of other vendors.
At Point of Billing
eCare® CMS Claims Management includes Medical Necessity as part of our comprehensive list of claims edits, ensuring that a claim will not go out if it does not meet criteria. An interface from the Point of Registration system reconciles ABNs to the final claim.
At Point of Care
Our electronic physician order component (eOrders) allows the physician to place an order online and check medical necessity while the patient is still in the office. The order is stored in a secure repository and immediately available for retrieval by the hospital.
How do I get more information?
Send an email to info@nebo.com
Call Carolyn Nottingham at 817-346-1193
