Medical Policy

Claims Adjudication and Payer Rules under ICD-10

Rayellen Kishbach's picture

Because we process thousands of LCDs updates weekly for our Coding Suite, we often get some insights that we can share. With the implementation of ICD-10, a significant drop off in the number of local coverage determinations (LCDs) and coverage articles published by the Medicare Administrative Contractors (MACs) has occurred. (See table in the white paper link below). While this may be partly due to MAC consolidation, it has left providers with less guidance than before about the proper coding and billing of covered services.

How do Medical Review professionals keep up?

Rayellen Kishbach's picture

The ever-increasing pace of healthcare benefit and coverage policy change makes it harder than ever for medical review professionals to make quick, completely informed policy and reimbursement decisions. Without the right information and tools, your organization’s exposure to risk increases. This risk is multiplied when you have to monitor and comply with updates across multiple states.

Understand Local and National Coverage with MAC Coverage Articles

Rayellen Kishbach's picture

We know understanding Medicare coverage is a challenge, and we've just made this challenge easier by upgrading all of our health care products to include Medicare Administrative Contractor (MAC) Local Coverage Articles. These articles can provide a deeper explanation of the MAC Local Coverage Determination (LCD) logic, or explain special topics like non-covered services, self-administered drug lists, coding rules for National Coverage Determinations (NCDs) and more.

Subscribe to RSS - Medical Policy