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Practice Information


Medicare uses a variety of mechanisms to set policies for coverage of services. At the national level, the Centers for Medicare and Medicaid Services (CMS) may issue a National Coverage Determination (NCD). Medicare administrative contractors (MAC) may issue Local Coverage Determinations (LCDs) or may choose to cover services or therapies on a case-by-case basis. If an NCD or LCD does not exist, it does not simply mean that Medicare will not pay for the service.

When national coverage has not been specified in NCD, MACs may choose to provide coverage for a service through an LCD. An LCD may be written in a manner that provides broad coverage, coverage with certain restrictions, or non-coverage. MACs develop LCDs through a process that is less formal than that used to develop an NCD. That process includes expert feedback from designated physician representatives. In Florida these include our CAC Representatives listed about who attend three formal meetings per year and consult with our carrier, First Coast Service Options.

Additional Tools for Practices
This tool provides current and draft local coverage determinations (LCDs), when they exist, for Medicare-covered procedure codes. Not every procedure code is covered by an LCD. For previous versions of an LCD, refer to the CMS Medicare coverage database. Click here for the tool.

Heart House has developed a network of CAC representatives from across the nation that meet as a group to review trends and analyze issues. The chair of the Third Party Reimbursement Committee is active at the national level through meetings and constant communication with colleagues.

National ACC has a web portal dedicated to practice issues. See this link for in-depth issues."Do Your PART" to Improve the Prior Authorization Process 

Payer-directed prior authorization for diagnostic imaging and medications is a tremendous barrier to patient care in today's cardiovascular care landscape. Help the ACC improve the prior authorization process by expanding the current data collection of inappropriate denials and difficult cases. ACC members and their staff are encouraged to submit instances of incorrect prior authorization denials for cardiac procedures and PCSK9 prescription through ACC's Prior Authorization Tool (PARTool) suite. Robust data collection is the first step to identifying and correcting exhaustive administrative burdens. Do your PART to improve the prior authorization.
Submit your data at ACC.org/PARTool today!


Keep Your Practice Up-to-Speed With APMs

Have you visited ACC's Alternative Payment Models (APM) Hub? Recently, the APM Hub was updated to provide a more in-depth look at the Merit-Based Incentive Payment System (MIPS) APMs, and to include an overview of the Health Care Payment Learning & Action Network (HCP-LAN) goals. Learn more about the different types of APMs, quality measures and bundled payments by visiting the Hub here. Also, read up on how many reporting and data submission deadlines associated with quality programs have been extended here.

CMS Expands Accelerated/Advance Payment Program

Using new flexibility from the recently passed Coronavirus Aid, Relief, and Economic Security (CARES) Act, CMS is expanding its program for accelerated/advance payments to improve Medicare providers' short-term financial footing and ensure necessary resources. This funding could help practices meet commitments, but care should be taken to budget for payoff since advance payments are offset by future claims. Learn more and make sure your practice has the resources it needs.

CMS Publishes New 2019 Open Payments Data; Check What Industry Says It Paid You

Pre-publication review and dispute for the CMS Open Payments Program Year 2019 data is available now through May 15. CMS will publish the Open Payments Program Year 2019 data and updates to the previous program years' data in June. The database shows "transfers of value" from industry, including any compensation that drug, device, biological and medical supply manufacturers report that they provided to physicians and teaching hospitals for the 2013-19 payment years. Your ACC encourages all cardiologists to check their newly updated Open Payments profile. Of note, CMS does not mediate or facilitate disputes; they must be resolved working directly with reporting entities. View a Physicians and Teaching Hospital Review and Dispute Tutorial here, and a CMS Quick Reference Guide here.

Update to ICD-10 and Other Coding Revisions to NCDs in April 2020

A new Centers for Medicare and Medicaid Services' MLN Matters Article on International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) – April 2020 Update is available. Learn about new and revised codes for NCDs, see relevant NCD coding changes in CR 11491 for: NCD 20.9 Artificial Hearts and Related Devices; NCD 20.9.1 Ventricular Assist Devices; NCD 20.34 Percutaneous Left-Atrial Appendage Closure; NCD 110.4 Extracorporeal Photopheresis; NCD 190.11 Home Prothrombin Time/International Normalized Ratio (PT/INR) Monitoring for Anticoagulation Management; NCD 260.9 Heart Transplants, and more. Read the update.

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Florida Chapter, American College of Cardiology
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