Local Coverage Determinations - HOW THE FL CHAPTER ACC GETS INVOLVED TO GET PATIENTS THE RIGHT CARE AT THE RIGHT TIME
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
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
This week, the Centers for Medicare and Medicaid Services (CMS) announced that physicians will have the option to opt-out completely or partially from the 2020 Merit-Based Incentive Payment System (MIPS) program by completing a hardship exemption application and indicating it is due to the COVID-19 public health emergency. Individual clinicians and group practices have until Dec. 31, 2020 to complete the hardship application. Learn more.
HHS has formed a 10-week virtual learning community, “Telemedicine Hack,” to accelerate telemedicine implementation for ambulatory providers. The community will meet every Wednesday through Sept. 23, from noon – 1 p.m. ET. The program will include “teleECHO” sessions on key topics and case studies from the field, virtual office hour discussion panels, peer-to-peer learning through virtual discussion boards, and CME/CEU credit. Register and learn more here. Also, the American Medical Association is seeking clinician input as part of a Telehealth Impact Physician survey, an effort of the COVID-19 Healthcare Coalition. Survey responses will build on existing research to help provide insights to federal and state policymakers, and identify gaps in current research. Take the survey here.