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This article gives notice to providers that Associated Hospital Service (fiscal intermediary) has begun converting Local Medical Review Policies (LMRPs) to Local Coverage Determinations (LCDs) and associated supplemental instruction articles.
Background:
Section 522 of the Benefits Improvement and Protection Act (BIPA), created the term "local coverage determination." The Centers for Medicare and Medicaid Services (CMS) published the final rule establishing LCDs on November 11, 2003. Beginning December 7, 2003, local policies are now referred to as LCDs, and contractors will issue draft and new policies as LCDs. Over the next two years, all existing LMRPs will be converted to LCDs.
Definition of Local Coverage Determination:
An LCD is a decision by a fiscal intermediary or carrier whether to cover a particular service in accordance with Section 1862(a)(1)(A) of the Social Security Act (i.e., a determination as to whether the service is reasonable and necessary). The difference between LMRPs and LCDs is that LCDs consist only of "reasonable and necessary" information, whereas LMRPs may also contain benefit category or statutory exclusion provisions. The "reasonable and necessary" information from the LMRP will be converted to an LCD with the remaining information (benefit category, statutory exclusions, and coding provisions) either converted to a supplemental instruction article or deleted at contractor discretion.
Until the conversion of LMRPs to LCDs is complete, the term LCD, will refer to both:
Reasonable and necessary provisions of an LMRP and,
An LCD that contains only reasonable and necessary language.
Publication of Local Coverage Determinations:
LMRP, LCD and supplemental instruction articles can be found on the Medicare Coverage Database (www.cms.hhs.gov/mcd) and on the Associate Hospital Service Web site (www.ahsmedicare.com). Articles summarizing new LCD revisions will continue to be published in medimessage as they occur.
"Reminder: Help reduce the national Medicare Claims Payment Error Rate, Please submit medical records when requested by the CERT contractor, AdvanceMed. If you have any questions about CERT, please call:
Massachusetts: Kathleen Kelly 617-689-2640
Maine: Carol Cherry 207-822-8825
Maine-If you have any questions regarding this Medimessage, please contact a Medicare Part A Representative at 1-888-476-7218, Option 4.
Massachusetts-If you have any questions regarding this Medimessage, please contact a Medicare Part A Representative at 1-888-628-6793, Option 1.
This Medimessage should be shared with all health care practitioners and managerial members of the provider staff. Medimessages are available at no cost from our website at www.ahsmedicare.com
POSTED 01/06/04 - LM
Background:
Section 522 of the Benefits Improvement and Protection Act (BIPA), created the term "local coverage determination." The Centers for Medicare and Medicaid Services (CMS) published the final rule establishing LCDs on November 11, 2003. Beginning December 7, 2003, local policies are now referred to as LCDs, and contractors will issue draft and new policies as LCDs. Over the next two years, all existing LMRPs will be converted to LCDs.
Definition of Local Coverage Determination:
An LCD is a decision by a fiscal intermediary or carrier whether to cover a particular service in accordance with Section 1862(a)(1)(A) of the Social Security Act (i.e., a determination as to whether the service is reasonable and necessary). The difference between LMRPs and LCDs is that LCDs consist only of "reasonable and necessary" information, whereas LMRPs may also contain benefit category or statutory exclusion provisions. The "reasonable and necessary" information from the LMRP will be converted to an LCD with the remaining information (benefit category, statutory exclusions, and coding provisions) either converted to a supplemental instruction article or deleted at contractor discretion.
Until the conversion of LMRPs to LCDs is complete, the term LCD, will refer to both:
Reasonable and necessary provisions of an LMRP and,
An LCD that contains only reasonable and necessary language.
Publication of Local Coverage Determinations:
LMRP, LCD and supplemental instruction articles can be found on the Medicare Coverage Database (www.cms.hhs.gov/mcd) and on the Associate Hospital Service Web site (www.ahsmedicare.com). Articles summarizing new LCD revisions will continue to be published in medimessage as they occur.
"Reminder: Help reduce the national Medicare Claims Payment Error Rate, Please submit medical records when requested by the CERT contractor, AdvanceMed. If you have any questions about CERT, please call:
Massachusetts: Kathleen Kelly 617-689-2640
Maine: Carol Cherry 207-822-8825
Maine-If you have any questions regarding this Medimessage, please contact a Medicare Part A Representative at 1-888-476-7218, Option 4.
Massachusetts-If you have any questions regarding this Medimessage, please contact a Medicare Part A Representative at 1-888-628-6793, Option 1.
This Medimessage should be shared with all health care practitioners and managerial members of the provider staff. Medimessages are available at no cost from our website at www.ahsmedicare.com
POSTED 01/06/04 - LM
