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This Monday Minute reminds home health and hospice about the significance that the LCD can have in the medical review of Medicare charts.

Hello everyone, and welcome to our Monday Minute. Today I want to remind you about a very important document that the Medicare MACs have developed to help assist agencies in understanding the expectation of your medical record documentation. The Local Coverage Determinations (LCD)have been developed by the Medicare MAC, approved by CMS, and are definitely used by their medical review teams to medically review your documentation to ensure it meets the expectation of Medicare regulation. These Local Coverage Determinations are developed for many provider levels, there are ones for Home Health, and there are ones for Hospice. In the case of Hospice, the Local Coverage Determinations are typically specific to a diagnosis code or a disease process that could be considered a terminal condition for a Hospice patient. Alzheimer’s, for example, is definitely one of the Local Coverage Determinations that we have seen used in medical review of Hospice charts and has resulted in denials because the documentation did not meet the Local Coverage Determination requirements. Technically, the Medicare reviewers are not supposed to deny a claim based solely on the lack of content as compared to the Local Coverage Determinations, but we have seen it happen. These Local Coverage Determinations contain the elements of documentation that they expect to see in the chart. In some cases, the levels of tests and that kind of thing including the modalities that they expect to see when we’re talking about a discipline specific LCD such as physical therapy, or occupational therapy in home health. They are very detailed. They are again, probably the third time I’ve said this now, used very specifically in medical review. Some of the Local Coverage Determinations were just updated with new implementation dates of October 1, 2021.   You’re going to want to make sure that your quality assurance departments, audit teams, your field staff all have access to the updated versions of the Local Coverage Determinations and are using them when looking at the documentation that your field staff is providing to ensure you are meeting those requirements.

I want to thank you all for participating today. Thank you all for being on the front lines as always and caring for patients during this Public Health Emergency. And I hope you have a fabulous week to come.

Palmetto LCDs

https://www.palmettogba.com/palmetto/jmhhh.nsf/DID/8B3RW86238

CGS LCDs

https://www.cms.gov/medicare-coverage-database/reports/local-coverage-final-lcds-contractor-report.aspx?contractorName=9&contractorNumber=all&lcdStatus=all

NGS  LCDs

https://www.ngsmedicare.com/web/ngs/medical-policies?lob=93618&state=97282&region=93623