VOOM Medical Necessity and ABNs

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Patience Norman
8 years ago
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1 Summary VOOM is the order entry system for Vanderbilt outpatient clinics. VOOM is an electronic application that communicates orders for diagnostic tests and provides access to the Vanderbilt charge capture application. ICD-9 codes are selected by the VOOM user for each diagnostic test ordered for a patient. Upon selecting an ICD-9 code the user is prompted with new on-screen icons used to identify if the test requires the user to obtain an Advanced Beneficiary Notice (ABN) or waiver form prior to completing the test. ABN forms and waivers are required for diagnostic tests and services that are deemed not medically necessary, non-covered services, or denied experimental. This allows VUMC Billing to hold patients financially responsible for all diagnostic tests that are not deemed medically necessary. Failure to obtain a patient signature on an ABN form or waiver for a non-medically necessary, non-covered services, or denied experimental diagnostic test or service will result in the cost of the test being unrecoverable. An on-screen Medical Necessity Alert has been placed in VOOM to alert users to the requirement of the ABN form or waiver when one is required. It is the responsibility of the user that orders the diagnostic test to obtain patient signature on the ABN form or waiver prior to completing the test. ABN forms and waivers are specific to Medicare, private insurance, and other assistance programs. All versions of the forms are available to print in E-Docs and can be located using keyword ABN. Definitions Advance Beneficiary Notice (ABN): form signed by the patient before receiving certain items or services that may not be deemed medically necessary. The form provides written notice to the patient that Medicare may deny payment for that specific procedure or treatment or the patient will be personally responsible for payment if Medicare denies payment. Waiver (Advance Notice of Financial Responsibility): form signed by the patient before receiving certain items or services that may not be deemed medically necessary by his or her private insurer. The waiver provides written notice to the patient that his or her private insurance company may deny payment for that specific procedure or treatment or the patient will be personally responsible for payment if insurance denies the payment. P a g e 1

Create a new order, or select an existing order. 3.

2 Icons in this job aid Information Steps Select ICD-9 Code in VOOM Order 1. Open VOOM to order outpatient diagnostic test. 2. Create a new order, or select an existing order. 3. Click to open the ICD-9 drop down menu next to the order name: 4. Single click to select an ICD-9 code from the list of available codes. P a g e 2

3 Determine Medical Necessity of ICD-9 1. After choosing an ICD-9, view the Med Nec column in the order. 2. A checkmark icon in the Med Nec column indicates that the ICD-9 chosen deems the test medically necessary. An ABN or waiver is not needed. 3. A hazard sign icon indicates that the ICD-9 does not deem the test medically necessary. An ABN or waiver should be completed. If the Med Nec column is blank, VOOM does not yet have data to determine whether or not the ICD-9 qualifies as a medical necessity, and it is not necessary to include an ABN or waiver at this time. VOOM is updated to include new Med Nec requirements on a regular basis. P a g e 3

4 Submit Order 1. Submit the order in VOOM. 2. If there is a hazard icon in the Med Nec column, you will receive a Medical Necessity Alert. 3. Click Yes to proceed with the chosen ICD-9 and obtain a signed ABN or waiver. 4. Click No to revise the order or choose an alternative ICD-9 code. Selecting an alternative ICD9 code is appropriate in the following scenarios: a. VOOM user entered ICD-9 code in error b. A more descriptive ICD-9 code exists for that diagnosis If you are unsure if your scenario qualifies to choose an alternate ICD-9 code, please check with your senior billing manager or clinic manager for guidance before proceeding. P a g e 4

5 Locate, Print, and Scan ABN Forms and Waivers 1. VOOM User or appropriate clinic staff should open E-Docs: 2. Enter keyword ABN and click Search. 3. Select appropriate ABN or waiver form based on patient s insurance provider. 4. Click Print next to selected ABN or waiver form. 5. Obtain patient signature on ABN or waiver form prior to performing the ordered test. 6. Follow your clinic s process for getting the signed ABN or waiver form scanned into the patient s health record in StarPanel. It is the responsibility of the VOOM user that orders the diagnostic test to obtain patient signature on the ABN form or waiver prior to completing the test. Failure to obtain a patient signature on an ABN form or waiver for a non-medically necessary diagnostic test will result in the cost of the test being unrecoverable. If you have questions about accessing E-Docs, obtaining patient signature, or uploading a signed ABN or waiver form, please contact your senior billing manager or clinic manager for guidance on the process in your clinic. P a g e 5

The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle.

The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle. This Revenue Cycle Overview training will establish a