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