reimbursement@wiki

 

COVERAGE

• Medicare Coverage Database
• • Search - Allows users to search both the NCD and LCD databases using a variety of criteria such as key word, coverage topic, and date
  • Indexes - Provides users with pre-defined lists of National and local coverage documents
  • Reports - Provides users with reports of National and local coverage data
  • Download - Allows users to download complete sets of LCDs and articles and the complete set of NCDs

NCD

• Revised Process for Making Medicare National Coverage Determinations (68 Fed Reg 55634-55641)

• • What constitutes a complete, formal request

• Factors CMS Considers in Opening a National Coverage Determination
• How to Request an NCD

LCD

• Medicare Program Integrity Manual, Chapter 13 Local Coverage Determinations
• Policies - LCD/NCD Overview and LCD Reconsideration Process
• Local Coverage Determination Process

LCD v. LMRP

• In 2003, CMS finalized regulations that replaced LMRPs with LCDs.
• • The difference between LMRPs and LCDs is that LCDs consist of only “reasonable and necessary” information, while LMRPs may also contain benefit category and statutory exclusion provisions.
• The final rule establishing LCDs was published November 11, 2003.  Beginning December 7, 2003, local policies were referred to as LCDs. 
• For more information, see the Medicare Program Integrity Manual, Chapter 13 (Local Coverage Determinations), at http://www.cms.hhs.gov/manuals/downloads/pim83c13.pdf.
  

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