 GEMS ABN Solution
ABN Verification Medicare and Compliance
Gaffey + Associates offers a solution to prevent your facility from writing-off millions of dollars each year, present more choices for your patients, and streamline workflow between your Patient Access and Patient Financial Services departments.
Our GEMS Advanced Beneficiary Notice (ABN) Verification and Medicare Compliance solutions are GEMS add-on software modules that verify Medicare outpatient claims for Medical Necessity and Compliance; to protect outpatient revenues and reduce exposure to unintentional fraud and abuse audits.
GEMS ABN Verification
- Allow every point of registration to access a secure website/database to verify ICD-9 diagnosis, revenue, CPT® codes, and National Coverage Determinations (NCD) for Compliance. A registrar can verify by code or description.
- All codes are linked to your Charge Description Master (CDM), which resides in the Gaffey + Associates data server.
- If it is discovered that an item or service may not be paid by Medicare, the option to print an ABN is available. The ABN is available in English or Spanish, and allows the patient to accept payment responsibility or deny service altogether.
GEMS Medicare Compliance
When an ABN is signed by the patient, the GEMS software system will keep a record of that ABN. Once Patient Financial Services runs GEMS Medicare Compliance, all signed ABN's will appear with their respective patient files.
Running Medicare Compliance essentially means checking your outpatient Medicare claims against the Local Medical Review Policies (LMRP's) published by your fiscal intermediary.
The GEMS Medicare Compliance module performs an edit by comparing four separate pieces of data on your claims to determine whether they meet Medicare Compliance policies:
- Bill type
- Revenue code
- HCPCS and/or CPT® code
- ICD-9 Diagnosis code
These codes are matched and compared with the LMRP's incorporated into GEMS Compliance edit tables. If the codes match correctly for the procedure's date of service, your claims meet compliance and will be permitted to download. If they do not match correctly, one of two types of errors will print on the error report and they will not be permitted to download.
Gaffey + Associates will update NCD, CPT® and ICD-9 diagnosis code tables annually, based on adoption and receipt of your Medicare intermediary. Depending on frequency of changes to your LMRP's, we will update these policies as needed.
Implementing GEMS ABN Verification and Medicare Compliance can immediately add value to your patient access and billing operations. Leverage this offer to manage revenues, assure compliance, and inform your patients. |
