Medical Necessity

DCS Global’s Medical Necessity is a web-based solution that helps provide accurate and timely outpatient medical necessity compliance checks at pre-service and point-of-access areas in hospitals and physician practices. This module assists the registration staff in verifying a patient's procedures and medical necessity quickly and easily based on the received diagnosis and procedure code information. Medical Necessity precisely matches the procedure code with the diagnosis code according to CMS guidelines for coding compliance. It identifies potential issues based on CMS policies. It also identifies procedures that have no matching diagnosis or CMS policy existing for the specific procedure code. Any errors or notifications are in real-time via work-lists so they can be coded correctly before the claim is billed.