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
Local Medical Review Policy • Also known as LMRP • Used to assist providers, physicians, and suppliers in submitting correct claims for payment
Local Policies • Outline how contractors will review claims • Must be consistent with national guidance • Are developed by contractor medical directors
LMRP - Medical Necessity • Diagnosis driven • Diagnosis must be covered under LMRP
National Coverage Decisions • National medical review policy - Labs
Non - Covered Services • Non Covered • Annual Check-up • Cosmetic Plastic Surgery • Services never covered by Medicare
ABN -Advanced Beneficiary Notice The patient must be notified if a service being provided might not be covered by Medicare and sign the ABN
LMRP Website http://www.lmrp.net/
LMRP Trailblazer Website http://www.the-medicare.com/ LMRP CPT 45380 DX 211.3
National Coverage DecisionsWebsite http://www.hcfa.gov/medicare/mr/lmrp.htm
National Coverage DecisionsWebsite http://www.hcfa.gov/coverage/default.htm
Advanced Beneficiary Notice Website http://www.hcfa.gov/medlearn/faqabns.htm