National coverage determinations (NCDs) and local coverage determinations (LCDs) are medical coverage policies that apply to Medicare Advantage claims and impact the way those claims are processed. NCDs are established by the Centers for Medicare & Medicaid Services (CMS) and apply to claims nationwide, while LCDs are established by each Medicare administrative contractor (MAC) and apply to claims within each MAC’s region. Typically, NCDs, LCDs and any related articles define coverage in terms of the appropriateness of a procedure with certain diagnoses.
To learn how claims are processed based on the appropriate NCDs and LCDs, check out Humana’s on-demand presentation, “Application of Medicare NCD/LCD Guidelines,” which gives an overview of Humana’s determination of coverage for patients with Medicare Advantage plans. A detailed, printable tip sheet attached to the presentation provides helpful hints and key resources to make working with these claims easier.
“Making It Easier for Physicians and Other Healthcare Providers” is a series of educational presentations about Humana’s claims payment policies and processes. Each feature in the series consists of an on-demand presentation addressing a specific topic, with its own downloadable tip sheet. New topics are added to the site as information is available, so be sure to check it regularly. Visit Humana.com/MakingItEasier to get started today!