In response to a provision of the 21st Century Cures Act, the Centers for Medicare & Medicaid Services (CMS) revised chapter 13 of the Medicare Program Integrity Manual (PIM). This chapter describes the local coverage determinations (LCD) process. One significant change is the relocation of billing codes (ICD-10-CM, CPT/HCPCS, Bill Type, and Revenue) from LCDs and into local coverage Articles. The MACs were expected to complete the work by January of 2020.
The Medicare Administrative Contractor (MAC) created a Billing and Coding Article that contains the codes removed from the LCD. The LCD and the Billing and Coding Article are companion documents. They are related to each other, and Medicare Coverage Database (MCD) users can see the relationship and access the related document by navigating to the “Related Local Coverage Documents” section in either the LCD or the Article.
More information on the changes made to PIM Chapter 13 and the LCD process can be found here: https://www.cms.gov/newsroom/fact-sheets/summary-significant-changes-medicare-program-integrity-manual-chapter-13-local-coverage.
LCDs and their associated articles are located in the MCD found here: https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx.
Denise serves as the Senior Vice President at Denial Research Group – AppealMasters. Denise is also President of The Association for Healthcare Denial and Appeal Management. Denise is a Registered Respiratory Therapist, Registered Nurse, and holds a Master’s degree in Management Information Systems from the University of Illinois, Springfield.
Denise has over thirty years of experience in healthcare, including clinical management, education, compliance, and appeal writing. Denise has extensive experience as a Medical Appeals Expert and has personally managed hundreds of Medicare, Managed Medicare, and Commercial appeal cases and presented hundreds of cases at the Administrative Law Judge level.
Denise is a nationally known speaker and dynamic educator on Medicare and Commercial appeals processes, payer behaviors, standards of care, appeal template development, and building a road map to drive the payer to a decision in the provider’s favor. She has educated thousands of healthcare professionals around the country in successfully overturning medical care denials.