Two Medicare cases illustrate the importance of NCDs and LCDs. Proving medical necessity is really no secret at all: Medicare national coverage determinations (NCDs) and local coverage determinations (LCDs) dictate which diagnosis codes must be documented by clinicians to support the medical necessity of most services or supplies they provide to patients. Coders who are ...
When ICD-10 documentation falls short on detail, help providers bolster it to find ideal codes. The two key principles that support diagnosis and procedure code selection are: Good clinical documentation: Documentation should accurately reflect the level of work for the care rendered, and support the selected diagnosis codes; and Demonstrated medical necessity: The Centers for Medicare ...
Be sure documentation proves the device is necessary, and determine the proper diagnosis code. Medicare defines the requirements for coverage of an implantable cardioverter-defibrillator (ICD) insertion in National Coverage Determination (NCD) 20.4, Implantable Automatic Defibrillators. The coverage falls into two major categories: primary prevention of sudden cardiac death and secondary prevention...
Proper documentation and verifying coverage criteria prior to claim submission can improve your chances for reimbursement. Many healthcare providers perform tobacco use counseling daily, but they may not be documenting or reporting it appropriately. Reliable guidance is needed to ensure all performed services are claimed and supported by complete documentation. Where Opportunity Knocks The Centers ...
Before denials and resubmissions take a toll on your practice, have a game plan that gets you paid. Fighting with an insurance company to get claims paid can be difficult. Accounts receivable staff must be on top of their game because incoming payments are needed to pay the light bill, the doctor’s malpractice premium, our ...