Local Coverage Determinations are extremely important . . .
Although coding guidelines, National Coverage Determinations (“NCD”), and other coding resource texts are among the most important resources available to healthcare providers, Local Coverage Determinations (“LCD”) are equally as important.
Local guidance is often overlooked by practices without intuitive software to catch concerns when providing services for Medicare beneficiaries.
Even billing systems with the ability to ‘scrub’ claims for these edits, they are updated frequently and can change the outcome of a submitted claim. Local Coverage Determinations provide us with a more targeted look into the diagnosis considered medically necessary by the Medicare Administrative Contractor (“MAC”), for the jurisdiction in which the service was performed. The MAC is a private health care insurer that has been awarded a geographic area or “jurisdiction” to regionally manage the policies and medical claims for Medicare Part A and Part B beneficiaries.
