A Lab Medical Necessity Check Software
LDS Analytics is an enterprise analytics platform that profiles and benchmarks lab orders and remittance by physicians, practices and labs. The system is designed to check every claim and improve meeting medical necessity to boost revenue by increasing reimbursement.
LDS Analytics checks each claim for CPT and ICD10 codes to improve meeting the medical necessity for reimbursement.
LDS Analytics checks submitted CPT codes against the procedure or test to determine if the correct CPT code is used.
LDS Analytics checks Medicare LCD policies to determine if the correct CPT and ICD10 codes are being used for the associated LCD.
LDS Analytics checks CPT and ICD10 codes for each submitted claim to determine if the correct lab test, CPT code and ICD10 code is used for a given diagnosis. The system has the capability to recommend an alternative lab test, CPT code or ICD10 code, if available, for each order, leading to improved reimbursement.
LDS Analytics utilizes a medical evidence-based score, calculated using Medical Database’s proprietary disease/test database and Medicare’s coverage database. The system is able to offer recommendations for more effective and clinically relevant tests and more accurate CPT and ICD10 codes, which will educate providers and improve reimbursement rates.
LDS Analytics provides the likely reasons for a payer’s denial of reimbursement for a test, which will improve the denial detection system for future claims.
LDS Analytics creates "on demand" reports for labs, individual providers and practices. These reports detail paid, partially paid and denied claims, as well as most commonly denied CPT codes, most common denial codes, and descriptions of the denial reasons.
LDS Analytics includes an http API interface that can be used to add orders in real-time as they arrive. Order data files may be uploaded and removed individually. The system supports numerous formats including HL7, through a Mirth Connect server.