To start with, what are they?
LCD stands for Local Coverage Determination, and NCD stands for National Coverage Determination. they are the 'rules' that Medicare applies to the different services and drugs that determine whether they will be paid or not. For example, a flu shot has to have two components: the flu shot administration (the actual giving of the shot) and the injectable medicine. If one piece is there but not the other, neither component will be paid.
The government (Centers for Medicare and Medicaid) came up with their set of rules, but when the Fiscal Intermediaries (the entities that contract with Medicare to administer their claims) began to process these claims, they discovered other issues that came up. For example, you can only have one flu shot a year. So they further defined the rules that Medicare created in order to make the claims process be more effective and cleaner.
So why do we need to know about these if we are not billing Medicare. Well, first of all, most offices are contracted with Medicare so you will have to deal with them. But second, wherever Medicare goes, all other insurances follow. So if your insurance contracts are not using LCD's and NCD's right now, you can bet they will in the future.
Read more about it here:
Until next time:
Have this blog delivered straight to your Kindle!
Reach me on Twitter @LorettaLea
#medbill #health #insurance
Author, Medical Billing, Coding, and Reimbursement
A medical billing professional for over 30 years now, I have seen a lot of changes in this field, and there are a lot more on the horizon. Follow me as we see what they mean and for who.