A number of smart LCD/MAC Policy users have asked for an easy way to tailor the product to automatically search just one state/data set for each payer, or to recieve weekly alerts for their favorite payer(s) about new policies.  This article contains simple instructions to make the LCDs work for you.

On August 28, 2010, Wisconsin Physicians Service Insurance Corporation (WPS), FI 52280, published Radiopharmaceutical Agents #RAD-026 V2 Approved DRAFT LCD. This draft LCD is one of the first, if not the first LCD, that establishes medical necessity criteria by specific CPT code procedure(s) for radiopharmaceutical agent reimbursement. The draft LCD Indications and Limitations of Coverage and/or Medical Necessity section indicates that radiopharmaceuticals will be considered medically necessary when used with the procedures listed in Table 1 of this draft LCD.

The AHA reports that CMS' New Issue Review Board approved the first "medical necessity review" audits last week.  The  audits include eighteen types of inpatient hospital claims and one type of DME claim. Remember that the RAC's must post the issues on their websites before issuing Additional Documentation Requests.  CMS expects the RACs to post the new audits and begin issuing ADR's within the next two weeks.  So, watch the RAC websites.  For your convenience, the issue pages on the RAC websites are:

The Centers for Medicare and Medicaid (CMS) require a provider to notify Medicare beneficiaries when a service may not be covered under the Medicare program. The new Advance Beneficiary Notice of Non-coverage (ABN), which became effective March 1, 2009, must be completed by the provider, or his/her representative, and signed by the patient, before a service is rendered.