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Local Medical Review Policy

Local Medical Review Policy

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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