ATLANTA, November 19, 2013 – 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.
“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.
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.