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Wiki 2022 benefit year Rad V Question re: LLPC

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Kinsley

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Hi everyone, I am hoping to get some clarity on the proposal that the use of the LLPC list and the use of Non-Edge claims will be discontinued for the 2022 benefit year? Has anyone else been made aware of this and is it possible that they are removing from RADV as a way to “add” a diagnosis that was not billed but it still can be used to “validate” a diagnosis. Looking forward to hearing all thoughts. Thank You!
 
Hi Kinsley,
Let s break it down to life long permanent conditions such as: chronic conditions vs forever codes. The chronic conditions which are ongoing for patients which can be COPD, Asthma, Arthritis, BMI obesity over 35 %, DM, CHKD, HTN, Sleep Apnea, CHF or heart conditions, Lumbar Back Pain,or Cancers. I gather non edge claims are not to be paid by the payer if a LLPC dx is on the claim? I do not know how an insurance company cannot cover these LLPC dx for an enrolled patient. What about the pre existing clause ? Wasn't that stopped years ago as payer denial reasons? I thought pre existing clause was no longer valid as denial with medical coverage.
Lady T
 
I am sorry, my question must not have been clear. Health Insurance is continuing to cover and reimburse for the LLPC conditions, of course. The proposal I am referring to is from CMS, who proposes to remove the LLPC and non Edge claims from the Rad V Audits, as a diagnosis that does not require "Meat". I look forward to your thoughts.
 
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