This course provides an overview of the Centers for Medicare and Medicaid Services (CMS) national and local coverage issues for services payable under Medicare Part B. The course will define the difference between local coverage determinations (LCDs) and national coverage determinations (NCDs), what coverage determinations are, why they were developed, and how they are used, and provide resources to obtain further, detailed information both nationally, and by state. Medicare provides access to a database that contains all National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) and proposed NCD decisions. Refer to the Resources section for a link to this database.
“This program has been approved for 0.5000 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.”
This activity is approved for 0.5000 contact hours.
Section 1: Introduction
About This Course
Section 2: Coverage Determinations
Purpose of a Coverage Policy
What Is Medical Necessity?
Section 3: NCDs
National Coverage Determinations
NCD Edits Updated Quarterly
Lab NCD Manual
Lab NCD Manual Example
ICD-10-CM Code Table Example
Coding Guidelines for All NCD Edits
Noncovered ICD-10-CM Codes for All NCD Edits
Noncovered ICD-10-CM Codes for All NCD Edits: Examples
Reasons for Denial
Section 4: LCDs
Local Coverage Determinations
Example of LCD by State Index
Determining Effective Coverage Decisions
Section 5: Conclusion
Veronica Ziac, MBA has over twenty years of healthcare administration experience. Her areas of expertise include revenue cycle, information systems, population health and physician practice management. Most recently, she was the Director of Revenue Cycle Integrity at Cobleskill Regional Hospital. Prior to that, Veronica was the Chief Operating Officer for a large multispecialty hospital-based physician practice based in New York. Veronica has an MBA in Healthcare Administration from Union College and a bachelor’s degree from the University at Albany. She is a member of HFMA and MGMA and has been Certified in Healthcare Compliance (CHC) by the Healthcare Compliance Association.
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