Local Coverage Determinations: The ABCs of LCDs

If your business provides medically necessary equipment or services to Medicare beneficiaries, it’s essential to know the ABCs of LCDs! In this post, we’ll start right at the beginning, investigating what LCDs are, how they help your clients get the care they rely on, and how they can impact how you do business. But, before we dive into the complex world of LCDs, we’d like to remind you that knowledgeable Medbill experts are standing by to answer your most pressing questions about the intricacies of Local Coverage Determinations.


What is a Local Coverage Determination or LCD?

LCDs, or Local Coverage Determinations, as opposed to National Coverage Determinations or NCDs (a topic for another post), are a set of specific decisions made by Medicare about what services and supplies are covered for beneficiaries. These decisions are based on an analysis of the best scientific evidence currently available and with input from various stakeholders, including doctors, clinicians, and consumer advocates.


Local Coverage Determinations help to ensure that Medicare beneficiaries have access to medically necessary services and supplies while also offering guidance to physicians, clinicians, providers, and other medical professionals about what is covered.


LCDs: Getting the Right Care to the Right Patients

Local Coverage Determinations are critical to ensuring that Medicare beneficiaries have access to medically necessary services and supplies while also providing guidance about what Medicare will cover. They identify the individual services and supplies that are covered or not covered for a specific diagnosis or procedure.


LCDs also specify the administrative mechanisms for paying for covered services and supplies. For example, services may be covered under Medicare Part A or Part B, or under a specific benefit category, such as home health services or outpatient rehabilitation services.


Local Coverage Determinations are developed using a process established by the National Coverage Determination (NCD) Program, in which the Centers for Medicare and Medicaid Services (CMS) work with stakeholders to identify and analyze gaps in coverage and to develop options for addressing those gaps in a meaningful way.


LCDs matter to Your Business. Here’s Why:

Understanding Local Coverage Determinations are essential to your business because, without them, it would be much more challenging to understand what services and supplies are covered under Medicare. Failure to follow the LCDs to the letter could result in your business overbilling or underbilling Medicare, which could lead to future audits and denied claims.


Additionally, LCDs can provide clear guidance on how best to serve your Medicare customers. With a clear understanding of what’s covered by Medicare, you can make sure that your business is providing the correct services and supplies. In short, following the guidance provided in Local Coverage Determinations can help ensure that you’re providing the best possible care for your Medicare-covered clients.


Medbill: Your Local Coverage Determination Expert

What we’ve discussed so far is merely the tip of the LCD iceberg. Before you continue your investigation into the all-important LCDs, we’d like to remind you that Medbill has the knowledge and experience to assist your business in navigating these often convoluted determinations and quite a bit more. Contact us today for a personalized quote and more information on how Medbill is ready to make your business more efficient than ever before.