Navigating the Medicare Coverage Database (MCD) Part B Provider Outreach & Education August 24, 2016

Transcription

1 Navigating the Medicare Coverage Database (MCD) Part B Provider Outreach & Education August 24, 2016

2 Housekeeping Hints Locating Presentation Materials Registration Package Reminder You have the ability to download or print the presentation (Optional) 2

3 Housekeeping Hints Dial in number : Conference Code: Audio/Dialing In *If you experience dial-in audio problems during the call, please press *0 for the operator help queue 3

4 Housekeeping Hints Chat Send us a message using Chat if you experience WebEx technical difficulties 4

5 Navigation Points Take Notes You have the ability to take & save notes (Optional) 5

6 Housekeeping Hints Interactive Evaluation Survey Evaluation will be made available during the Question & Answer session 6

7 Disclaimer This resource is not a legal document. This presentation was prepared as a tool to assist our providers. This presentation was current at the time it was created. Although, every reasonable effort has been made to assure accurate information, responsibility for correct claims submission lies with the provider of services. Reproduction of this material for profit is prohibited. CPT Disclaimer American Medical Association (AMA) Notice and Disclaimer All rights reserved. CPT is a registered trademark of the American Medical Association(AMA). Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors, and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. 7

8 Acronyms CMS Centers for Medicare and Medicaid Services DMEPOS Durable Medical Equipment, Prosthetics, Orthotics and Supplies LCD Local Coverage Determination MAC Medicare Administrative Contractor MEDCAC Medicare Evidence Development & Coverage Committee MCD Medicare Coverage Database NCD National Coverage Determination PIM Program Integrity Manual 8

9 Navigation Points MCD Detail Accessing MCD MCD Search Options Resources Cahaba Reminders 9

10 Utilizing the MCD Extensive Coverage Information Anticipate Reimbursement or Payment Denials Ability to provide written advance notice to beneficiary concerning possible denial of service/items Documentation Requirements Utilization Guidelines MLN/MLNProducts/downloads/ABN_Booklet_ICN pdf 10

11 MCD Guidelines National Coverage Determinations (NCD) The NCDs are developed by CMS to describe the circumstances for which Medicare will cover specific services, procedures, or technologies on a national basis. Medicare Contractors are required to follow NCDs. Local Medical Review Policy (LMRPs) An administrative and educational tool to assist providers, physicians and suppliers in submitting correct claims for payment. Local policies outline how contractors will review claims to ensure that they meet Medicare coverage requirements. Benefits Improvement and Protection Act of 2000 Medicare Contractors were required to convert their Local Medical Review Policies to Local Coverage Determinations (LCDs). Medicare Program Integrity Manual (PIM) Chapter 13 Local Coverage Determinations 11

12 MCD Content National Coverage Determinations (NCDs) National coverage information National Coverage Analyses (NCAs) Documentation supporting NCDs Local Coverage Determinations (LCDs) Coverage determinations established by Medicare Administrative Contractors i.e. Cahaba Local Articles Contains coding and other guidelines information 12

13 MCD Content Coding Analyses for Labs (CALs) Course of action for making changes to the laboratory coding component Medicare Evidence Development & Coverage Advisory Committee Proceedings (MEDCAC) Review & evaluate effectiveness and appropriateness of medical items and services covered or may be eligible for coverage under Medicare. Technology Assessments (TAs) Technology safety and efficacy regulation Coverage Guidance Documents Detailed information on the NCD process 13

14 MCD Document Status DRAFT Revision/New policy under development FINAL Active includes effective date, description of covered service, documentation requirements and information supporting medical necessity RETIRED Archived no longer in effect 14

15 Accessing the MCD Insert your desired text here

16 Cahaba Quick Links Select/Click - LCDs 16

17 Local Coverage Determination (LCD) Webpage 1. Draft LCD Meetings 2. LCD Comments & Reconsideration 3. LCD Documents 17

18 Local Coverage Determination (LCD) Webpage 1. Draft LCD Meetings 18

19 Medicare Local Coverage Determination Meetings Click/Select Seminar Title to Register 19

20 Local Coverage Determination (LCD) Webpage 2. LCD Comments & Reconsideration Click/Select LCD Comment and Reconsideration Link 20

21 LCD Comment & Reconsideration Processes Insert your desired text here. 21

22 Local Coverage Determination (LCD) Webpage 3. LCD Documents Click/Select State LCDs Link 22

23 Redirect Message 23

24 MCD Indexes Webpage 24

25 CMS Website Scroll down to Top 5 Resources Select/Click Medicare Coverage Database 25

26 Medicare Coverage Database 26

27 MCD Search Options Options 1. Overview for Quick Search 2. Advanced Search 3. Indexes 4. Reports 5. Downloads 27

28 MCD Overview Section Information 1. Special Announcements 2. Search Descriptors & Hyperlinks 3. Quick Search 28

29 MCD Overview Section Information 4. MCD Update Status 5. Archived Information 6. Public Comment Tool 29

30 MCD Overview Section Information 7. Related Links 30

31 Contractor Name & Number Table Contractor Name State Contractor Number Line of Business Cahaba Government Benefit Administrators Alabama Part A Cahaba Government Benefit Administrators Alabama Part B Cahaba Government Benefit Administrators Georgia Part A Cahaba Government Benefit Administrators Georgia Part B Cahaba Government Benefit Administrators Tennessee Part A Cahaba Government Benefit Administrators Tennessee Part B 31

32 Quick Search Feature Conduct searches by Document ID or by Document Type Two (2) Types of Quick Search: 1. Document ID 2. Document Type National & Local Coverage Documents National Coverage Documents Local Coverage Documents State/Region Title Keywords CPT/HCPCS Coding An asterisk (*) indicates a required field 32

33 Quick Search Document ID Example 1. Enter Document ID Example L34297 Click Search by ID 2. Enter Date of Service or Leave Blank Click Search An asterisk (*) indicates a required field 33

34 Document ID Search Results Click/Select LCD Title link to view 34

35 License Agreements to View Documents Read and Scroll to bottom of page to accept the CMS Licensing Agreement to view document(s) Click Accept to view document(s) 35

36 Coverage Determination Document Review 1. Type and Title of Coverage Document Z 2. Document Save/Print/ Options 3. Document Navigation by Section 4. Contractor Information 5. LCD Information LCD ICD-9 Information Effective Dates CMS National Policy Guidelines Coverage Indications, Limitations, and/or Medical Necessity Indications 36

37 Coverage Determination Document Review 6. Coding Information Bill Type Revenue Codes CPT/HCPCS Codes ICD-10 Codes Supporting Medical Necessity ICD-10 Codes that Do Not Support Medical Necessity 37

38 Coverage Determination Document Review 7. General Information 8. Revision History 9. Associated Documents 38

39 Draft Coverage Determination Example Prefix DL indicates Proposed/Draft policy 39

40 Draft Coverage Determination Document Example 40

41 Quick Search Document Type Example 1. Select Document Type Example National & Local Coverage Documents 2. Select Geographic Area/Region Example Georgia 3. Select One or Both Example - Screening Click Search by Type An asterisk (*) indicates a required field 41

42 Document Type Search Results Document Type Search Yields 37 Records 10 National Coverage Determinations (NCDs) 0 Local Coverage Determinations (LCDs) Click to expand & access documents 42

43 Document Type Expanded Results 43

44 Advanced Search Advanced Search Options 1. Search by Document ID 2. Search by Document Type An asterisk (*) indicates a required field 44

45 Advanced Search by Document Example 1. Select Document Type Example National & Local Coverage Documents 2. Select Document Criteria Example NCDs, MEDCAC, All Policies (LCD) An asterisk (*) indicates a required field 45

46 Advanced Search by Document Example 3. Select Geographic Area Example Georgia 4. Select Contractor Criteria Example All Cahaba Government Benefit Administrators An asterisk (*) indicates a required field 46

47 Advanced Search by Document Example 5. Enter Keyword(s) Search Example lesions 6. Select Keyword Criteria Example Entire Document (searches for entire document for Lesions ) An asterisk (*) indicates a required field 7. Optional Filters Place Check in Desired Filter Example CPT/HCPCS Click Search 47

48 Advanced Search Results Advanced Search Yields 34 Records 48

49 Advanced Search Expanded Results Record Breakdown 29 NCD Records 4 MEDCAC Records 1 LCD Record Expanded LCD Information LCD ID# LCD Title see Lesions highlighted in title Contractor Name Click LCD ID Number to view LCD Document 49

50 Indexes Contains Pre-Defined Lists of National & Local Coverage Determinations 50

51 Indexes Search Example Expanded Local Coverage Index Search Links: LCDs Articles Contacts Click/Select LCD Link Title Example LCDs by State 51

52 Indexes Search Example 1. Select State Example - Georgia 2. Select Document(s) Example Active LCDs Click Submit An asterisk (*) indicates a required field 52

53 Indexes Search Results Index LCD Search Yields 66 Records 53

54 Indexes Search Sorting Sort Search Results by using the Column Arrows Column Sort Options LCD ID Number Title Effective Date Revision Effective Date End Date Late Updated Status Select/Click Document Title to access document 54

55 Reports Customizable Report Searches 1. National Coverage What s New Annual Report 2. Local Coverage What s New Status Report Last Updated Report Article Status Report Self-Administered Drug- Exclusion Report 55

56 Reports Example 1. Select/Click Report Type Link Example Local Coverage What s New Report 56

57 Reports Example 2. Select/Click Contractor Type Example All Cahaba GBA LLC Contractor Listings 3. Select Database Update Date from dropdown menu Example 02/07/2016 An asterisk (*) indicates a required field 57

58 Reports Results Report Results Yields 4 Records Select/Click Document ID to access document 58

59 Downloads Provides ability to download Access Databases containing: All Current LCDs All Current & Retired LCDs All Current Articles All Current & Retired Articles All NCDs/Public Comments for NCAs/CALs 59

60 Downloads Additional Information Additional Information provides: Content options Data Set Limits Computer Requirements Zip File Instructions 60

61 Accessing the MCD Archive Select/Click MCD Archive Site Documents located in Archives: Local Coverage documents (i.e. Local Medical Review Policies (LMRPs) LCDs Articles Access to the MCD Archive Site Link can be located on: MCD Overview Page MCD Downloads Page 61

62 MCD Archive Research Gateway 62

63 Basket Ability to Print/Download Selected Documents 63

64 Resources Cahaba GBA Website Centers for Medicare and Medicaid Services How to Use the Medicare Coverage Database Guide MLN/MLNProducts/downloads/MedicareCvrgeDatabase_ICN pdf Internet-Only Manual (IOM) Pub Manuals-IOMs.html Local Coverage Contacts MCD Archive User Guide 64

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67 Question & Answer To Ask a Question Dial-in number: Conference Code: For claim specific questions, please call: Provider Contact Center Interactive Evaluation on WebEx Select the Survey Tab at the top of your screen, enter your responses, and click the submit button OR Submit your evaluation by accessing the link sent in the your reminder 67

68 Evaluation Survey Interactive Evaluation on WebEx Select the Survey Tab at the top of your screen, enter your responses, and click the submit button OR Submit your evaluation by accessing the link sent in the your reminder 68

69 Thank You for Your Participation Today! 69