Medicare Claims Analysts
“Medical Necessity” is a term that has been used in recent years by Medicare and may not be familiar to you. “Medical Necessity” means that there are procedures and services physicians may prescribe for you that they may feel are necessary to manage your health. However, Medicare may not pay for certain services based up on their policies.
In the past, Medicare has covered most procedures. With the emergence of MRI, CT Scan, and other sophisticated and costly services and procedures as the diagnostic methods of choice, it is important for you to know what procedures and services will be covered by asking your physicians and or Medicare. We also encourage you to discuss with your physicians other treatment options available to you that may give them the information that they need to treat you. If your physician orders a procedure or service that Medicare may not cover, you may be asked to sign an Advance Beneficiary Notice (ABN). The ABN informs you in advance that Medicare is not likely to pay for the procedure or service, and that you will be responsible for payment. By signing the ABN, you are indicating that you understand and agree to be personally and fully responsible for payment.
Medicare beneficiaries are responsible for deductibles and co-insurance. If you receive services as an outpatient or in outpatient observation, you will be billed for non-covered oral drugs and some injectable drugs that fall under the category of Self-Administered. Please refer to the online version of National Medicare Handbook at www.medicare.gov or call 1-800-633-4227 if you need more information.
Do You Have Any Options?
You can agree to be financially responsible for the procedure by signing the ABN form, or you can refuse the test or services. If you refuse the test or services, you will also be asked to sign a form indicating you’ve elected not to have the service. If you request the services and will not sign the ABN, you will still be responsible for payment. If you need services that are not covered by Medicare, you will be responsible for payment. You have the right to appeal a Medicare decision not in your favor. If you would like to appeal a Medicare decision, or have other Medicare questions, please contact the Medicare beneficiary hotline at 800-633-4227.
Send Us Your Story
Lenoir Memorial has added a feature to its website at www.lenoirmemorial.org. Those with hospital stories they'd like to share can click on the "Send Us Your Story" tab on the home page and will be taken to a special form created for you to tell us your Lenoir Memorial story. Submissions can be private or public depending on what you prefer. Send us your story. Through your hospital stories we can continue to work towards a patient-centered care environment for our patients and continue on our mission to provide exceptional healthcare for the people we serve.LEARN MORE
HealthLink - Winter 2015
Check out the latest edition of Lenoir HealthLink! Download the pdfLEARN MORE
Lenoir Memorial Board votes to pursue strategic partnership with Novant Health
After a yearlong selection process for a strategic partner, the Lenoir Memorial Board of Directors has unanimously voted to pursue a partnership through a management agreement with Novant Health, hospital officials announced today. The decision follows a thorough search and exploration process led by the board to select a partner who would best position Lenoir Memorial for the future of healthcare and create a stronger health system for the Kinston community. "For more than a century, Kinston has had a community hospital and the chapter we're beginning today will preserve that legacy of local healthcare for future generations," said Gary Black, president and CEO of Lenoir Memorial. "Through an affiliation with Novant Health, we will further enhance the services we provide, ensuring that high-quality care remains close to home." The Lenoir Memorial Board now enters discussions with Novant Health to structure the terms of the partnership, leading to the signing of the management agreement, which the board hopes to finalize this spring.LEARN MORE
Affordable Care Act and Healthcare Marketplace
Lenoir Memorial plays a vital role in educating uninsured patients about their coverage options and helping them navigate the Marketplace. There are several ways to apply for health coverage. You can apply online using a laptop or desktop computer. (You may not be able to complete the application using a smartphone or tablet.) You can also fill out a paper application, apply over the telephone or apply in person at certain sites. Find out more about the different ways to apply here. Certified Application Counselors (CAC) are available within Lenoir Memorial to educate consumers and aid them in completing an application for coverage. If you have questions or wish to set up an appointment, you may contact Terrence Body, social worker at 252-522-7977, a patient accounts counselor at 252-522-7000 or call 800-318-8596 at any time of day, seven days a week. Or visit HealthCare.gov.LEARN MORE
Yoga and Flexibility: Limber up with some smart poses!
Being sore and having tight muscles can really slow you down on a daily basis, and even more so during exercising. Did you know that yoga is a great practice that can increase limberness, while also keeping muscles and joints healthy? Join Graham as he discusses yogo positions that will stretch your muscles, loosen up tightness, and relax your whole body!LEARN MORE
What’s App with that?
Learn what Apps you can download to help you with glucose management, exercise, and nutrition. Join Sandra and Angie for this informative talk and be sure to bring your smart phone or tablet. No advanced reservations required. If you have questions call Sandra at 252-522-7616.LEARN MORE
Turning up the heat: How sun smart are you?
Warmer weather, longer days, and the relaxed energy of summer make it a perfect time to enjoy your favorite outdoor hobbies. Join Brittney to test your knowledge and gain some healthy tips on exercising in the heat. Free to the public.LEARN MORE
Get Your Rear In Gear - November 5
This free colorectal screening clinic is for men & women age 40 and up who have never been screened for or had colorectal cancer. The clinic will be led by members of the WellAare team and the Lenoir Memorial Gastro staff. This screening is funded in part by a grant from Get Your Rear in Gear - Kinston and the Lenoir Memorial Foundation. Call 522-7014 to complete required registration.LEARN MORE
Get Your Rear In Gear - Sept 10
This free colorectal cancer screening clinic is free for men and women age 40 and up who have never been screened for or had colorectal cancer. The clinic will be led by members of the WellAware team and the Lenoir Memorial Gastro staff. This screening is funded in part by a grant from Get Your Rear In Gear-Kinston and the Lenoir Memorial Foundation. Call 522-7014 to complete the required registration.LEARN MORE