ATLANTA, May 8, 2012 /PRNewswire/ -- Craneware, Inc.,
the market leader in automated revenue integrity solutions, today
announced the availability of new features to InSight Medical
Necessity®, its all-payor medical necessity verification
solution. Because medical necessity is one of the greatest causes
of denials today, representing a threat to provider organizations'
revenue integrity, Craneware has enhanced InSight Medical Necessity
to help healthcare organizations save staff time in ensuring
compliance with medical necessity and prior authorization
requirements.
Medical necessity verification is an essential front-end
component and best practice for optimal revenue cycle performance.
According to a recent American Hospital Association survey of more
than 2,000 hospitals, nearly 80% currently list medical necessity
as the organization's top reason for complex denials. It is a
daunting task for clinical and administrative staff to manually
attempt to track payors' medical necessity policy updates and prior
authorization requirements. InSight Medical Necessity enables staff
to quickly check medical necessity for all payors from any
Internet-accessible location.
Building on the most comprehensive set of payors' medical
necessity requirements available today, enhancements to the
web-based InSight Medical Necessity include:
- Customizable keyword picklists that support users with limited
coding knowledge to choose the appropriate procedures when
performing medical necessity validations
- Commercial payor prior authorization coverage for ensuring
accurate patient access checks in accord with each payor's unique
prior authorization policies
- Newly expanded reporting capabilities that identify medical
necessity results by Current Procedural Terminology (CPT) code and
physician, which helps administrators identify and prioritize
common problem areas and opportunities to provide education
"As hospitals and healthcare organizations work to ensure
revenue integrity in order to continue providing quality healthcare
to their communities while remaining as cost-effective as possible,
it is vital that they implement automated tools that improve
overall business processes," said Keith
Neilson, CEO of Craneware. "Spurred by our commitment to
providing software that supports accurate, efficient and
sustainable business processes in healthcare, and armed with years
of lessons learned, Craneware has enhanced our medical necessity
solution to address the most significant challenges associated with
medical necessity verification, coding and administrative
reporting. Timely accurate medical necessity communications help
honor the needs of patients and providers to know what to expect
from payor plans."
InSight Medical Necessity supports fast verification of medical
necessity in any area of the healthcare organization's operations,
from scheduling and registration to order entry and medical
records. Enhanced reporting allows administrators to identify
problem areas by tracking and trending medical necessity and prior
authorization failures by procedure and physician. Medical
necessity is verified against a comprehensive payor requirements
database with weekly auto-updated coverage for major state,
federal, non-profit and commercial payors in the U.S. Having an
effective, efficient process for medical necessity verification in
place will ease the transition when ICD-10 takes effect.
InSight Medical Necessity automatically issues Advance
Beneficiary Notices (ABNs) and patient responsibility waivers using
up-to-date CPT, HCPCS and ICD-9 codes, and it links directly to the
chargemaster file to reflect actual pricing on the ABN.
To learn more about Craneware and to receive a demonstration of
the enhanced InSight Medical Necessity solution, visit the company
at the National Association of Healthcare Access Management (NAHAM)
38th Annual Educational Conference and Exposition, May 8-11 in San
Diego, booth #509. Craneware is a business partner member of
NAHAM.
About Craneware
Craneware (AIM: CRW.L) is the leader in automated revenue
integrity solutions that improve financial performance for
healthcare organizations. Craneware's market-driven, SaaS solutions
help hospitals and other healthcare providers more effectively
price, charge, code and retain earned revenue for patient care
services and supplies. This optimizes reimbursement, increases
operational efficiency and minimizes compliance risk. By partnering
with Craneware, clients achieve the visibility required to
identify, address and prevent revenue leakage. To learn more, visit
craneware.com and stoptheleakage.com.
SOURCE Craneware, Inc.