Changes to National Government Services Local Coverage Determination Process

In accordance with Section 4009 of H.R. 34-21st Century Cures Act (Public Law No: 114-255), CMS is updating the “Medicare Program Integrity Manual” with detailed changes to the LCD process. These changes were communicated in CMS Transmittal 863, issued on 2/12/2019.

Please ensure your staff is aware of the LCD revisions and transition of all coding to related articles. There has been no change in coverage associated with this update.

• All coding information, will be removed from the LCDs and placed in a related billing and coding article, including national coverage provisions, and associated information (documentation requirements, utilization guidelines).
• The article name will begin with “Billing and Coding,” followed by the title of the associated LCD.
• Bill types, revenue codes, CPT/HCPCS codes, ICD-10 codes, as well as any coding guidance or mention of codes in the LCD will now be found in the associated billing and coding article.
• Several LCDs will be revised for 8/1/2019 publication. The remaining LCDs will be revised in the coming months, with all completed by 1/1/2020.
• Billing and coding articles will be listed on the Medical Policy Center page alongside the related LCD.

 

 

Related Content

• More details on this update are available in MLN Matters® Article MM10901.
• For a complete listing of all LCDs, visit the Medical Policy Center

For the first time, the July 2019 issue of MLMIC’s Case Review is available here as a podcast (see below). 

This allows policyholders and non-policyholders alike to listen to an audio version of each case study and its accompanying legal and risk management analysis. 

The cases in this new issue include:

•  Case Study #1:  Gastroenterologist and Hospital Absolved after Disastrous Outcome
• Case Study #2:  Poor Communication Regarding Medical Management Results in Patient Death

The June 2019 issue of MLMIC’s Albany Report, is now available here. 

It offers a concise, insider’s  view of pending legislative, regulatory, and political developments that have an impact on the New York State medical professional liability insurance marketplace.

 

As a surgeon advocate within your state, the ACS Division of Advocacy and Health Policy (DAHP) needs your immediate assistance to help garner additional opposition to legislation moving through the U.S. Senate, the Lower Health Care Costs Act of 2019 which seeks to address unanticipated/surprise medical billing.

Recently, this issue has garnered much public attention, and has risen to the level of congressional action. While the ACS continues to work with Congress to propose meaningful solutions to address this issue, the College needs your help in opposing this legislation introduced by Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA).

This legislation includes a federally benchmarked payment rate tied to the in-network median rate to resolve the issue of surprise billing and excludes a fair Independent Dispute Resolution (IDR) process.
 

Let Us Amplify Your Voice!

A sample email message has been crafted for you and will take less than 2 minutes to send via SurgeonsVoice    If you prefer, you may also send a traditional letter.  A sample is available for you.

As the Governor Liaison to the ACS Legislative Committee, I would like to report that the Committee has had a busy year thus far, with ongoing developments regarding multiple issues, the most salient of which are highlighted in this newsletter.

You can help these causes not only by writing your Congressional Delegates, but also by becoming active at the State level within the New York Chapter of the ACS. Please be an ACS Advocate, even if only at your local government level: truly it can make a difference-or rather, should I say, YOU can make a difference. Best wishes to all for a happy and safe July 4th.

Anthony J. Vine, MD, FACS
Asst. Clinical Professor of Surgery,
Icahn School of Medicine at Mount Sinai Hospital, NY, NY
Laparoscopic Surgical Center of NY

Enclosed is this newsletter:

• 2019 New York Legislative Recap
• Supporting the Chapter's SurgeonPAC
• Surgical Specific Issues (At-a-Glance) Addressed this Year
• House of Medicine Highlights and Achievements