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.
Lenoir Memorial enters into management agreement with UNC Health Care
The Board of Directors of Lenoir Memorial Hospital has unanimously voted to enter into a management services agreement with UNC Health Care, hospital officials announced May 16. Discussions regarding an affiliation began between the Lenoir Memorial board and UNC Health Care leadership earlier this year. The board recognized the extraordinary opportunity to partner with a flagship healthcare leader in the state - defined by excellence in research, clinical advancements and quality of care - was one not to be missed. It became clear that an agreement with UNC Health Care will best position Lenoir Memorial to create a stronger hospital for the Kinston community for generations to come.
"We are excited about our partnership with UNC Health Care and look forward to the vast array of support they will offer us here at Lenoir, said Gary Black, president and CEO. "Our board has been very thoughtful in this process and we believe that this partnership will allow for the growth of services in this community. UNC Health Care is very much aware of the challenges facing community hospitals in this economic environment and has assured our board that they can assist us in addressing the challenges and maintaining healthcare close to home. It is our belief that an affiliation with UNC Health Care will best position Lenoir Memorial to continue our mission to ensure exceptional healthcare to the people we serve."
Lenoir Memorial employees will keep their current positions and will remain employees of Lenoir Memorial, a private, not-for-profit hospital, not the state. This agreement does not involve any sale or exchange of assets and will allow Lenoir Memorial to maintain local governance. "We are pleased to welcome Lenoir Memorial Hospital into our system of 10 hospitals and hospital systems, our physician's networks and our affiliation with the UNC School of Medicine," said William L. Roper, MD, CEO of UNC Health Care. "This partnership with Lenoir Memorial Hospital will continue our efforts to provide the highest quality care to our patients across North Carolina."
This affiliation will allow Lenoir Memorial to provide a broader scope of resources and experience to benefit its patients. Some of the primary benefits include:
- Expansion of locally available hospital and community-based patient care services to enhance patient care.
- Improved patient experience and satisfaction
- Enhanced operational efficiency
- Recruitment of additional highly trained and skilled physicians
- Access to cutting-edge research and treatments at UNC Health Care
Be Informed About Mental Health Crisis Resources for Lenoir County
Mental Health Crisis:
- 24/7 crisis services for Lenoir County are available by calling Eastpointe Access Center at 1-800-913-6109 or for TTY 888-819-5112. Customer Services Specialists will assist you to find a crisis provider.
- Mobile Crisis Teams are available 24 hours a day. Professional counselors will speak with you and your family during a visit. They have an average response time of 2 hours. This service is provided by Easter Seals-UCP 800-913-6109
- The crisis center in Lenoir County is provided by PORT Human Services, located at 2901 N. Herritage St., Kinston, NC 28501 252-233-2383. Appointments are not needed for crisis assessment and referral services, Monday - Friday, 8 a.m. - 5 p.m.
- To be connected to a skilled, trained counselor at a crisis center in your area 24/7 call the National Suicide Prevention Lifeline at 1-800-273-TALK(8255)
- The 24/7 National Suicide Prevention Lfeline Network for Lenoir County is provided by REAL Crisis Intervention by calling 252-758-4357 for free counselling and extensive referral services.
Free Medication Wallet Card
Call the Minges Wellness Center at 252-522-7014 to get your free medication wallet cared and we can mail one directly to your home! Keeping an up-to-date record of your medicines may help protect you from a mistake.
- First, it helps you and your family remember all the medicines you are taking. Next it helps your doctors, nurses, and pharmacists make sure that the medicines prescribed for you can be taken safely together.
- A list also helps make sure that important medicines you take at home will be continued if you are hospitalized.
- Finally, your medicine list will help your doctor determine if any illness or symptoms you experience could be related to the medicine you take.
Use a medication list or card to keep a record of all the medicines, vitamins, and dietary supplements or herbs you take. Keep the list updated and share with your pharmacist and physician. The medication wallet cards are free but limited to one per person.LEARN MORE
Lenoir Memorial first in area to get Varian TrueBeam linear accelerator
Lenoir Memorial Hospital will be one of the first facilities in eastern NC to install the Varian TrueBeam Linear Accelerator, the most advanced radiation therapy machine. We are the proud recipients of this cutting-edge technology due to the tireless efforts of the Lenoir Memorial Foundation and the generous donations made by members of our community.
Lenoir Memorial's approach to fighting cancer is to stay on the cutting edge of technology, provide unparalleled treatment options and maintain the highest standard of care for our patients. The benefits of the Varian TrueBeam Linear Accelerator include the following:
- Highly improved imaging capabilities for patient positioning prior to treatment.
- Advanced IMRT/Motion monitoring provides real time imaging, which monitors patient positioning during treatments and turns off the machine automatically when the patient falls out of range of the set treatment parameters.
- Faster treatment times are possible because treatments come in higher dose rates. Typical treatment times are just 2-3 treatment delivery minutes.
- SmartConnect Remote Monitoring means decreased downtime and allows for remote diagnosis and service.
Lenoir Memorial Cancer Center expects to begin treating patients with the new Varian TrueBeam Linear Accelerator on July 11, 2016. If you have any questions regarding cancer treatment, please feel free to contact our Cancer Center at 252-522-7600.LEARN MORE
Lenoir Memorial Enters Exclusive Negotiations with UNC Health Care
The Board of Directors of Lenoir Memorial has unanimously voted to pursue exclusive negotiations to create a management services agreement with UNC Health Care, hospital officials announced today. Discussions regarding an affiliation began between the Lenoir Memorial board and UNC Health Care leadership earlier this year. The board recognized the extraordinary opportunity to partner with a flagship healthcare leader in the state - defined by excellence in research, clinical advancements and quality of care - was one not to be missed. It became clear that an agreement with UNC Health Care will best position Lenoir Memorial to create a stronger hospital for the Kinston community for generations to come.
"With this partnership, we have the opportunity to expand high-quality healthcare and a deeply respected brand to our part of the state. We are confident this partnership will preserve the Lenoir Memorial legacy of local healthcare for future generations," said Gary Black, president and CEO of Lenoir Memorial Hospital. "Adding access to UNC's groundbreaking research and focus on advancing clinical care and our commitment to the patients we serve enhances what we can deliver together, close to home."
The Lenoir Memorial Board now enters discussions with UNC Health Care to complete details of the agreement which the board hopes to finalize in April. Both parties agree that when a contract between Lenoir Memorial and UNC HealthCare is finalized it will not involve any sale or exchange of assets and will allow the board to maintain local governance of the hospital. Lenoir Memorial employees will keep their current positions and will remain employees of Lenoir Memorial, a private, not-for-profit hospital, not the state.
"We are pleased to affiliate with Lenoir Memorial Hospital and welcome them into our system," said William L. Roper, MD, CEO of UNC Health Care. "This partnership combines the successful healthcare delivery at Lenoir Memorial Hospital will help advance our system's mission of providing excellent care, training the next generation of North Carolina's physicians, and conducting groundbreaking research."
This affiliation will allow Lenoir Memorial to provide a broader scope of resources and experience to benefit its patients. some of the primary benefits include:
- Expansion of locally available hospital and community-based patient care services to enhance patient care.
- Improved patient experience and satisfaction.
- Enhanced operational efficiency.
- Recruitment of additional highly trained and skilled physicians.
- Access to cutting-edge research and treatments at UNC Health Care.
Similarly, UNC Health Care entered into a management services agreement with Wayne Memorial Hospital in nearby Goldsboro, NC in December 2015.
For more information about Lenoir Memorial visit our website at www.lenoirmemorial.org
For more information about UNC Health Care visit their website at www.unchealthcare.orgLEARN MORE
Benefits of Mind/Body Exercise
Tai Chi and Yoga are POWERFUL! Low impact activities that have a high impact on your health! Come learn the history behind these ancient practices. Learn the many benefits:
- Improved conditions including arthritis, high blood pressure, and relieves chronic pain.
- Lowers stress
- Improves balance
Learn how to coordinate your muscles, bones, heart, and mind! Silver and Fit social immediately follows this class with free light refreshments.LEARN MORE
What Get Measured Gets Managed
Join Brittney Bradshaw at this FREE seminar to discuss or learn more about your preferred food tracker.
- Is there evidence that supports technology in tracking exercise and nutrition and what have your experiences been?
- The number one fitness trend right now is wearable technology and how is the benefit worth the hype?
- Who should be tracking food in a diary technology?
Get the answers to these and other questions and offer your personal use suggestions! There are so many, bring your own experiences and learn from others! Silver and Fit social immediately follows with complimentary refreshments.LEARN MORE
Find Out What’s Cookin in Kinston
Holly White, RD,LDN, will be preparing and offering samples of collards flavored using vegetables instead of meat. Come learn as Holly shares tipsfor preparing healthy dishes using fresh local produce.LEARN MORE
Brain Attack - Stroke Risks and Symptoms and the Importance of Early Treatment
Join Dr. Manasi Gahlot, Lenoir Neurology Neurologist, as she discusses the importance of realizing the symptoms of stroke and reacting quickly if you think someone is having a stroke. If stroke is suspected think FAST: F - Face is uneven, A - Arm is weak, S- Speech is strange, T-Time to call 911. This educational offering is free and groups are welcome!LEARN MORE
HealthyLife Weigh 2016 series
This weight management program focuses on weight loss goals supported by healthier nutrition practices and increased physical activity. It is ideal for the individual needing to lose 10-40 pounds, and at a stage of readiness where lifestyle changes can be made. Nutrition education is delivered in a 4 week program led by a registered dietitian in the Minges Wellness Center at Lenoir Memorial. The program is a modified form of the national program, HealthyLife Weigh, and focuses on the necessary formula for permanent weight loss: balancing calorie intake from food and calorie output through physical activity. We will assist you in making permanent lifestyle changes to help you get to and stay at a healthy body weight. This is not a diet but a new way of incorporating positive eating and activity habits. Each series consists of 4 classes that cover portion control, nutrition, grocery shopping, and emotional eating. Participants will receive 2 months membership in the Minges Wellness Center with an individual exercise plan developed with an exercise specialist. Required registration may be completed by calling 252-522-7014. Cost is $150. Dates and times: Jan 6,13,20, 27 @ 8:30 a.m., Feb, 8,15,22, & 29 @4:00 p.m., March 10,17,24 &31 @ 12:00 p.m., Apr 6,13,20 & 27 @ 4:00 p.m., May 3,10,17,24 @ 8:00 a.m., Jun 1,8,15 &22 @ 12:00 p.m., July 7,14,21 & 28 @ 4:00 p.m., Aug 10,17,24, & 31@ 8:30 p.m.,Sept 6,13,20 & 27 @ 12:00 p.m., Oct 5,12,19,26 @ 4:00 p.m. and Nov 8,15,22 & 29 @ 8:00 a.m.LEARN MORE