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.
Hospital welcomes new physician
Michael Diamond, M.D., has joined the staff at Kinston Community Health Center. Diamond graduated from Wake Forest University with an undergraduate degree in Communications. He obtained his medical degree from the Brody School of Medicine at East Carolina University. He has a special interest in Pediatrics and Internal Medicine. Diamond completed his residency at Vidant Medical Center in Greenville, NC. He is single and he enjoys volunteering for community efforts such as sports physicals, health fairs, and legislation advocacy.LEARN MORE
Smith named PSEA of the Year
At the February Lenoir Memorial Board of Directors meeting, Chairman Ray Collier named Eveyln Smith, RN, Medical Oncology President's Service Excellence Award honoree for 2012. An excerpt from Smith's nomination read, "Evelyn Smith provides compassionate and quality care to the patients she servs on Medical/Oncolory on a daily basis. She exhibits outstanding interpersonal skills, which complement her ability to communicate in a clear, concise and accurate manner. when interacting with patients and staff. She has the ability to work very effectively and efficiently with cross funcational teams. She holds herself accountable high ethical standards and legal requirements setting an example to other staff." Congratulations Evelyln Smith!LEARN MORE
HealthLink - April 2013
Check out the latest edition of Lenoir HealthLink!LEARN MORE
New Care Giver Support Group
Meetings will be held the first Monday of each month beginning April 8 at 2 p.m. in the Neuse Room. This group is free of charge and intended to offer support to those who are caring for adults who are ill and/or elderly. Topics for meetings will be designed to address the emotional, physical, and spiritual health of the caregiver. Please contact Lisa James Coffman, MSW, at 252-527-3786 at Continuum Home Care & Hospice of Kinston for more details.LEARN MORE
McDaniel Sleep Center opens
The McDaniel Sleep Center, located near the Minges Wellness Center, was opened July 2 after this unused area of the facility was revamped. The center was named for the McDaniel family whose ancestors donated a home to be used as the first hospital in Lenoir County. The McDaniel’s granddaughter, Laura McDaniel Walker of Long Beach, Calif., made a generous donation and named the center in memory of the original donors, he said. “I’m grateful that (the family) thought of the idea to name the whole center,” Griffith said. The development of the new sleep center was partially funded by $180,000 in donations, said Dirk Griffith, director of the LMH Foundation Board. Each room has its own personality and exhibits a plaque designating a donor’s name. They look like typical bedrooms, but with state-of-the-art medical equipment in them. The rooms even feature a flat-screen television and are individually temperature-controlled. “The new suites have nice large bathrooms for each room,” Dail said.LEARN MORE
2013 Colorectal Cancer Screening Dates
This free 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 WellAware team and the Lenoir Memorial Gastro staff. Screening sponsored by the Lenoir Memorial Foundation. Call 252-522-7014 to complete required registration.LEARN MORE
Getting ready for flip-flops?
Are flip-flops really a good idea for people with diabetes? What about those exposed toes? Join Sandra as she shares information about routine foot care for individuals living with diabetes. Coe learn about the importance of self-exams, foot care and the potential complications uncontrolled diabetes can have on your feet.LEARN MORE
7 Ways To Get A Work-out On Vacation!
Vacations usually mean a two-week hiatus from physical activity and fitness but it doesn't have to. There are many ways that you can sneak in a work-out without disrupting the leisurely vacation that you have been craving all year. Join Tara and find out the 7 tips to keep you motivated while on vacation! Free to the public.LEARN MORE
Obesity and Diabetes
According to the Center for Disease Control, we are eating ourselves into a diabetes epidemic. Dr. Mitra shares how weight is tied to the functions of the pancreas and hormones. Free to the public - no registration required. Groups welcome!LEARN MORE
Obesity and Heart Disease
Your body is made up of water, fat, protein, carbohydrate and various vitamins and minerals. If you have too much fat — especially around your waist — you’re at higher risk for health problems, including high blood pressure, high blood cholesterol, diabetes, heart disease and stroke. In this presentation, Dr. Mitra makes the connection with heart disease and high blood pressure. Free to the public - no registration required. Groups welcome!