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BC Advantage - 2021 Issue 4

58% of Improper Payments due to Medical Necessity for Ventilators

Proper documentation not only protects the provider, the payer, and the patient, it protects the integrity of the entire healthcare system. When it comes to coverage and documentation for durable medical, the DMEPOS supplier and staff must be familiar with the National and Local Coverage Determinations (NCDs and LCDs) as these are two of the most important aspects of Medicare. NCDs and LCDs are used by Medicare and their administrative contractors for coverage determination information and determining if the service is reasonable and necessary, as well as if it will be reimbursed by Medicare. Medicare and its contractors...

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