CMS Medical Necessity (NCD - LCD)
With this functionality you can automatically check all procedures you have scheduled or coded against the CMS NCD - LCD data source. This guide will walk through the areas this is found within GoRev as well as how to use it.
The CMS data source used:
We maintain a current data source for CMS LCD - NCD by accessing the files here: https://www.cms.gov/medicare-coverage-database/downloads/downloads.aspx
Medical Necessity Checking in Scheduling
When utilizing the Scheduling system within GoRev (Guides:GoRev Scheduling Table of Contents) you can find the Medical Necessity tab here
This will open the medical necessity procedure grid. This system will perform a medical necessity check against the CMS data sources for any procedure code you have entered into the CPT Codes tab. It will also check all procedure codes within any preference card(s) attached in the Preference Cards Tab (Guide: Preference Card Designer).
Red lines indicate medical necessity has not been satisfied using any of the diagnosis codes currently entered.
Double click and you are presented with the list of diagnosis codes found within the related NCD or LCD. Use the bottom right search to instant search through these codes. Diagnosis codes relative to the patient found within a valid physician order or medical documentation can be added by right clicking and clicking Add Diagnosis.
Right clicking on a red row and then clicking View Article will open a web browser and take you to the specific NCD - LCD web page.
Medical Necessity Checking in Coding
Medical necessity checking can be found as shown in the tab below within the Coding module. Functionality is the same as is found above in the Scheduling module.
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GoRev Support Team
If you have any questions, concerns, or problems regarding this GoRev Tutorial, please contact the GoRev Support Team by submitting an IT Support Ticket, by phone at 1-(317)-794-3900, and/or by email at ask@gorev.com.
Note: If possible, always submit an IT Support Ticket detailing any problem that you are experiencing within GoRev. This will give GoRev Support Agents access to additional information that will help expedite the resolution of your issue. If you are unsure how to submit an IT Support Ticket in GoRev, please see theIT Support Ticket Creation for assistance.