Hospitals: Stay On Top Of Ever-Changing Coverage Determinations

Why This Topic Matters

Coverage policy changes can alter whether claims are paid, denied, or challenged, so staying current helps hospitals reduce avoidable denials and compliance problems.

Article Sections

1. Get to the Nitty-Gritty: LMRPs

   Introduces the older local Medicare review policy framework and explains its role in coverage review and claim processing. The section also contrasts it with related local determination concepts.

2. Move on up to LCDs

   Describes the shift to local coverage determinations and the broader transition period affecting Medicare contractors. It also discusses the types of policy information providers may need to review when handling coverage challenges.

3. Understand the Big Picture With NCDs

   Summarizes national coverage determinations and the more centralized policy development process. The section also notes changes that affect timing, draft review, and public comment.