How to Research LCDs and NCDs for Coding Information
Description
In this course, participants will gain a comprehensive understanding of Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) and their critical role in the medical coding and reimbursement process. The course will provide practical guidance on locating and interpreting these determinations using the Medicare Coverage Database (MCD), along with real-world examples. Topics covered include definitions, the structure and content of the MCD, searching for articles and related documents, and understanding the implications of LCD and NCD requirements on coding practices.
Included Lessons:
- Introduction
- Definitions
- Medicare Coverage Database
- How to Search the Main Medicare Coverage Database (MCD)
- How to Search for Articles and Related LCDs and NCDs
- Medicare A/B Medicare Administrative Contractor (MAC) Jurisdiction Map and List
- What Topics are Covered in LCDs and NCDs?
- Modifiers and Condition Codes
- What if NCD/LCD Requirements are Not Met?
- Common LCD and NCD Topics Searched
- Practice Cases
- Locating LCDs Through MAC Sites
- Organizational Impact
CEUs available for the following credentials:
AHIMA
CCA, CCS, CCS-P, RHIT, RHIA, CDIP, CHDA, CHPS
Key Takeaways
- Understanding LCDs and NCDs: Gain a clear comprehension of what Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) are, including their definitions, purposes, and the distinctions between them.
- Navigating the Medicare Coverage Database (MCD): Learn how to effectively search and utilize the Medicare Coverage Database to locate pertinent LCDs, NCDs, and related articles, ensuring accurate and up-to-date information.
- Interpreting Coverage Guidelines: Develop the skills to interpret and apply the guidelines and criteria outlined in LCDs and NCDs to ensure compliance and appropriate coding for Medicare and other payors.
- Applying Real-World Examples: Use practice cases and examples to understand how to apply LCD and NCD information to actual coding scenarios, enhancing practical coding skills.
- Handling Modifier and Condition Codes: Understand the appropriate use of modifiers and condition codes in relation to LCD and NCD requirements, ensuring accurate and compliant coding practices.
- Implications of Non-Compliance: Learn the consequences of not meeting LCD and NCD requirements, including potential financial liabilities and the necessity of advance beneficiary notices (ABNs) or hospital-issued notices of non-coverage (HINNs).
- Keeping Updated: Recognize the importance of staying informed about updates to LCDs and NCDs, as these can change frequently, and how to subscribe to updates from Medicare Administrative Contractors (MACs).
Benefits of Taking this Course
- Improved Accuracy and Compliance
- Enhanced LCD and NCD Knowledge and Skills
- Better Communication
- Up-to-Date Knowledge
- Problem-Solving Skills
- Increased Efficiency
- Professional Development
- Error Reduction
FAQs
What are LCDs and NCDs, and why are they important?
Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) are guidelines developed by Medicare to outline the criteria for coverage and payment of specific medical services and procedures. LCDs are specific to regional contractors, while NCDs apply nationwide. Understanding these determinations is crucial because they impact coding accuracy, compliance, and reimbursement.
What is the difference between an LCD and an LCA?
An LCD (Local Coverage Determination) is developed by Medicare Administrative Contractors (MACs) to define medical necessity criteria within their jurisdictions. An LCA (Local Coverage Article) provides additional coding and billing guidance related to an LCD but may also stand alone. LCAs often include details on covered diagnoses, procedure codes, and required modifiers.
Can LCDs and NCDs affect both inpatient and outpatient coding?
Yes, LCDs and NCDs can affect both inpatient and outpatient coding. For example, an NCD for defibrillator insertion will have clinical indicators that must be documented for both inpatient and outpatient settings to meet medical necessity criteria.
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