How to Prevent Medical Necessity Denials

How to Prevent Medical Necessity Denials  is organized by Practice Management Institute (PMI) and will be held on May 06, 2021.

Accreditation:
Earn 1.5 PMI CEUs for attendance at this program. Practice Management Institute grants CEUs for its certified professionals based on total number of instructional hours (1 CEU per hour of classroom instruction). CEUs may be applied to annual recertification requirements, as directed in the certification renewal requirements for your credential(s).

Description:
Is your practice receiving denials for medical necessity? Have you been checking for NCDs-LCDs and medical policies before you submit a claim? Has your appeal been denied because you failed to follow the carrier’s guidelines?

The Local coverage determination (LCD) by a MAC defines whether or not a service is covered. Medicare contractors develop LCDs when there is no National Coverage Determination (NCD) to ensure that services being paid for by Medicare are medically necessary, or if there is a need to clarify an existing NCD.

In 2018 CMS revised chapter 13 of the Medicare Program Integrity Manual which describes the LCD process. In response to the 21st Century Cures Act, the agency aimed to increase transparency, clarity, consistency, reduce provider burden. CMS instructed the MACs to remove codes from LCDs by January 1, 2020 and place them on billing and coding articles or policy articles published to the Medicare Coverage Database (MCD). These articles directly link to the LCD policy allowing coders to readily find the guidance needed on coding for claim submission of services related to an LCD.

Is your practice using the tools CMS has designed for you? Join this session to improve your knowledge and properly navigate carrier coverage determinations. Maxine will include a real-life example of the cost to the practice that bills and receives payment for items that are later audited and determined to be out of compliance with requirements in the coverage guidelines. Educate yourself and safeguard your providers’ reimbursement.

Additional details will be posted as soon as information is available.