Local Medical Review Policy

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

• Services never covered by Medicare

• Non Covered
• Annual Check-up
• Cosmetic Plastic
• Surgery

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