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Local Medical Review Policy - PowerPoint PPT Presentation


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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


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    1. Local Medical Review Policy Presented by: Susan Magdall, CPC, CHC Institutional Compliance Program

    2. Local Medical Review Policy • Also known as LMRP • Used to assist providers, physicians, and suppliers in submitting correct claims for payment

    3. Local Policies • Outline how contractors will review claims • Must be consistent with national guidance • Are developed by contractor medical directors

    4. LMRP - Medical Necessity • Diagnosis driven • Diagnosis must be covered under LMRP

    5. National Coverage Decisions • National medical review policy - Labs

    6. Non - Covered Services • Non Covered • Annual Check-up • Cosmetic Plastic Surgery • Services never covered by Medicare

    7. ABN -Advanced Beneficiary Notice The patient must be notified if a service being provided might not be covered by Medicare and sign the ABN

    8. LMRP Website http://www.lmrp.net/

    9. LMRP Trailblazer Website http://www.the-medicare.com/ LMRP CPT 45380 DX 211.3

    10. National Coverage DecisionsWebsite http://www.hcfa.gov/medicare/mr/lmrp.htm

    11. National Coverage DecisionsWebsite http://www.hcfa.gov/coverage/default.htm

    12. Advanced Beneficiary Notice Website http://www.hcfa.gov/medlearn/faqabns.htm