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Description of the topic:
The Medicare Carrier system is divided into geographical areas in which different carriers are contracted to adjudicate claims for Medicare Part A and B patients. NCD’s are National Coverage Determinations that give direction on billing and coding for certain procedures that apply to all providers in any geographical area. There is also a spreadsheet which for each NCD that describes the payable ICD-10-CM codes for the procedures in the policy, if applicable, along with other information needed for correct claims submission. In the absence of a NCD, a Local Coverage Determination, or LCD, may be created by a particular Medicare carrier for Part A or B benefits on a particular or group of procedures and/or services. The NCD would only apply to those states that are listed on the NCD, and cannot be applied claims for other jurisdictions. This can complicate things as one state may cover a service or procedure for a particular reason, but the next state may not. This webinar will show attendees how to locate the appropriate NCD’s and LCD’s for their area, and give direction on how to use the information in the policies.
The Center for Medicare and Medicaid Services (CMS) have different methods of sharing and publishing their policies and guidelines. Two of those methods are National Coverage Determinations (NCD), and Local Coverage Determinations (LCD).
Why should you attend?
Anyone who is involved in the documenting, coding, and billing should understand where to find these guidelines and what can be found in the policies. Medicare only covers services and procedures that are considered medically necessary. There are circumstances in which a provider may feel that something is needed for the diagnosis or treatment of a patient, however, Medicare does not feel that the patient meets their criteria for medical necessity, and so the claim is denied. A patient can be held responsible if they are notified in advance that they may be responsible, and they sign an Advanced Beneficiary Notice (ABN). NCD’s and LCD’s assist in knowing what conditions and/or problems are considered payable for a procedure or service.
Areas Covered in the Session:
Who will benefit:
biller, coder, manager, administrator, insurance collector, Medicare specialist.
Physical CD-DVD of recorded session will be despatched after 72 hrs on completion of payment
Lynn Anderanin, CPC, CPPM, CPMA, CPC-I, COSC, is the Sr. Coding Educator for Healthcare Information Services, a physicians revenue cycle management company. She has over 38 years experience in all areas of the physician practice, and has experience in oncology and rheumatology. Lynn is currently a Workshop and Audio Presenter. She is a former member of the American Academy of Professional Coders (AAPC) National Advisory Board, and has served on several other boards for the AAPC. She is also the founder of her Local Chapter of the AAPC.