Advanced Search

Home Health & Hospice Week

Industry Note:

Note LCD Denial Change

Published on Wed Nov 09, 2011

You'll get a little Christmas present from HHH MAC subcontractor National Government Services this month. On Dec. 27, NGS will begin allowing providers to initiate their own adjustments to claims that have been fully or partially denied by automated edits for national coverage determinations (NCDs) or local coverage determinations (LCDs). NGS notes in an e-mail message to providers. Currently, providers have to submit a written request to NGS for the MAC to make the adjustments. Why? "Most claims that are denied for reason codes 55A00, 52NCD, 53NCD, or 54NCD involve a diagnosis that meets the requirements of the NCD or LCD and that is appropriately documented in the provider's records," NGS explains. "However, the diagnosis code has been omitted from the claim." The new process will improve efficiency, the MAC says. NGS will allow provider-initiated adjustment when a 55A00, 52NCD, 53NCD, or 54NCD claim or line item has been denied [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Home Health & Hospice Week

View All