ATLANTA, Nov. 19, 2013 /PRNewswire/ -- Ensuring the
accuracy of medical necessity in real-time is a high priority for
hospitals' financial performance. Craneware, Inc., the market
leader in automated revenue integrity solutions, today announced
that Avera Health, a health network of more than 300 hospitals and
clinics in South Dakota,
North Dakota, Minnesota, Iowa and Nebraska, has purchased InSight Medical
Necessity®. Avera Health plans to implement InSight
Medical Necessity at 28 of their 33 hospital organizations to
provide automated, real-time, validation of medical necessity,
which mitigates compliance risk and payor denials while
facilitating required advance beneficiary notice (ABN) and
comparable commercial notification.
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"We realized a need for an all-payor medical necessity solution
that would seamlessly integrate with our existing MEDITECH health
information system, and be easy to implement and adopt. Through a
nationwide search, we found that Craneware's solution was the only
tool capable of meeting the needs of our hospitals," stated
Kathy Dorale, VP Health Information
Management from Avera Health. "Validating medical necessity at the
time services are requested facilitates compliance with ABN and
commercial payor guidelines, and Craneware's solution is flexible
enough to be implemented across all hospital locations in our
system, helping to reduce medical necessity denials."
Craneware's InSight Medical Necessity solution gives provider
organizations the ability to perform medical necessity checks in
real-time. The intuitive front-end medical necessity software helps
determine whether the diagnosis codes support the medical necessity
of the procedures ordered, or if prior authorization is required.
By flagging services with medical necessity issues at the time of
request, hospitals can ensure more accurate coding and compliance
while also educating ordering physicians on the documentation
required for validating the medical necessity of services for
Medicare and commercial payor plans.
"Medical necessity questions are a leading cause of both claim
denials and recovery audits," said Keith
Neilson, Craneware CEO. "Craneware's solution addresses the
most significant challenges associated with medical necessity,
which are verification, diagnosis and procedure coding, as well as
administrative reporting. This partnership with Avera Health is a
great example of how automated solutions can help improve
operational efficiency and reduce denials to achieve revenue
integrity."
InSight Medical Necessity is part of Craneware's Access
Management & Strategic Pricing product family. Craneware
Revenue Integrity Solutions® span four product families,
with the other three being: Audit & Revenue Recovery, Revenue
Cycle, and Supply Management. Craneware developed the industry's
first effective chargemaster management solution, Craneware's
Chargemaster Toolkit®, which has ranked number
one in the KLAS Revenue Cycle – Chargemaster Management market
category for the past seven years. In 2012, Craneware's Bill
Analyzer achieved number one ranking in the KLAS Revenue Cycle –
Other market category for the second year in a row.
About Avera Health
Avera, the health ministry of the Benedictine
and Presentation Sisters, is an award-winning regional health
partnership of health professionals who share support services to
maintain excellent care at 300 locations in eastern South Dakota, North
Dakota, Minnesota,
Iowa and Nebraska. Avera Health consists of 6 regional
acute facilities with direct ownership or management
responsibilities for 27 Critical Access Hospitals. Five
Avera hospitals are identified by
Healthgrades as among the top hospitals nationally for Excellence
in Patient Outcomes. Avera's
eEmergency service has been recognized as a winner of one of
only three Most Wired Innovator Awards given by Hospitals &
Health Networks (H&HN) magazine, and for thirteen
consecutive years achieved recognition as one of the nation's Most
Wired health systems. To learn more, visit www.avera.org.
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 helps
customers optimize reimbursement, increase operational efficiency,
minimize compliance risk, and retain more earned revenue. 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