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Local Medical Review Policy. Presented by: Susan Magdall, CPC, CHC Institutional Compliance Program. Local Medical Review Policy. Also known as LMRP Used to assist providers, physicians, and suppliers in submitting correct claims for payment. Local Policies.

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Local Medical Review Policy

Presented by:

Susan Magdall, CPC, CHC

Institutional Compliance Program


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Local Medical Review Policy

  • Also known as LMRP

  • Used to assist providers, physicians,

    and suppliers in submitting correct claims for payment


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Local Policies

  • Outline how contractors will review claims

  • Must be consistent with national guidance

  • Are developed by contractor medical directors


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LMRP - Medical Necessity

  • Diagnosis driven

  • Diagnosis must be covered under LMRP


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National Coverage Decisions

  • National medical review policy - Labs


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Non - Covered Services

  • Non Covered

  • Annual Check-up

  • Cosmetic Plastic

    Surgery

  • Services never covered by Medicare


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ABN -Advanced Beneficiary Notice

The patient must be notified if a service

being provided might not be covered by

Medicare and sign the ABN


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LMRP Website

http://www.lmrp.net/


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LMRP Trailblazer Website

http://www.the-medicare.com/

LMRP

CPT 45380

DX 211.3


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National Coverage DecisionsWebsite

http://www.hcfa.gov/medicare/mr/lmrp.htm


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National Coverage DecisionsWebsite

http://www.hcfa.gov/coverage/default.htm


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Advanced Beneficiary Notice Website

http://www.hcfa.gov/medlearn/faqabns.htm


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