CodeMap® Compliance Briefing: Breaking News:  12/12/2008

Many providers utilize automated systems to screen claims for medical necessity compliance. These systems check the combination of procedure codes and diagnosis codes included with each claim to ensure compliance with both national and local coverage policies. If providers do not properly maintain automated compliance checkers, they run the risk of submitting false claims, missing the opportunity to collect an ABN from the beneficiary, and/or receiving denials from their Medicare contractor.

On Tuesday, December 9, 2008, CMS published change request 6304 concerning significant changes to the National Coverage Determinations that govern commonly performed laboratory procedures. As most of our subscribers know, NCDs play an important role in communicating the coverage requirements of many common lab procedures. These polices spell out covered ICD-9 codes, including links to specific CPT^® codes, frequency limitations, and other indicati....

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