Payment & Practice Management  |   September 2013
Local Coverage Determinations: Where They Come From and Why They Matter
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Infectious Disease / Practice Management / Quality Improvement / Payment & Practice Management
Payment & Practice Management   |   September 2013
Local Coverage Determinations: Where They Come From and Why They Matter
ASA Monitor 09 2013, Vol.77, 60-63.
ASA Monitor 09 2013, Vol.77, 60-63.
My first column of the year asked the question, “Will 2013 be the year of the audit?” The article discussed the heightened compliance concerns that anesthesiologists and other physicians could anticipate in the coming year. It also touched upon some of the tools and resources practices can use to help ensure that their coding, billing and documentation will stand up to scrutiny. The May 2013 column continued that thought by featuring the National Correct Coding Initiative (NCCI). This month, we will cover another important compliance consideration: Local Coverage Determinations (LCDs).
National Coverage Determinations (NCD) are applicable to the entire Medicare program without regard to the specific geographic locale in which the item or service covered by the NCD is delivered. When there is no established national policy, Medicare Administrative Contractors (MACs) can develop LCDs that apply to care provided within their jurisdictions. LCDs inform the medical community of the conditions that must be present in order for the local contractor to consider a service or procedure to be covered and paid. Medicare is to cover only services that are reasonable and necessary. This standard is established in the Social Security Act, Sec. 1862. [42 U.S.C. 1395y]1 
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