National Coverage Determinations (NCD) - Articles

Clarify the Complexity Please! NDC Codes and Drug Classification Systems
April 20th, 2020 - Christine Woolstenhulme, QCC, CMCS, CPC, CMRS
Different Drug classification systems are used to categorize drugs to identify the medication, with each system having their own logic. There are four main drug classification systems used in the United States, not to be confused with a class of drugs or "Drug Class". A drug class is the way drugs ...
CMS says Codes are on the Move!
December 9th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Have you noticed your LCDs are missing something? CMS is moving codes out of LCDs and into Billing and Coding Articles. MACs began moving ICD-10-CM, CPT/HCPCS, Bill Type, and Revenue codes in January 2019, and will continue through January 2020. Therefore, if there is an LCD with its codes removed, you will find ...
NEW on Find-A-Code...National Coverage Determinations (NCDs)
January 23rd, 2018 - Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
Medicare limits its coverage of services to those considered to be reasonable and necessary for the diagnosis and treatment of an injury or illness based on coverage guidelines. National Coverage Determinations (NCDs) are created based on research, evidence-based processes, public participation, and other resources, and made available to the public. ...
What Does It Mean To Scrub An Insurance Claim?
December 29th, 2015 - David Greene, MD
During the rigorous training physicians undergo to learn their craft, very little education is received on how to deal with submitting claims to insurance companies. It’s unfortunately a necessary evil, as surgeons who contract with insurance companies rely on that reimbursement as the...
CMS expands coverage for three drug regimen to fight nausea during chemotherapy
September 3rd, 2014 - Scott Kraft
Physician practices will soon be able to get paid for use of a three-drug antiemetic regimen used to prevent nausea and vomiting by patients receiving chemotherapy for an expanded list of chemotherapy drugs, under a National Coverage Determination recently posted by CMS. The change in coverage is...
CMS NCD drops clinical trial requirement for FDG PET scans for solid tumors
May 6th, 2014 - Scott Kraft
Patients no longer need to be in a CMS-approved clinical trial for physician practices to get paid for doing as many as four FDG PET scans for solid tumors – one for an initial treatment strategy and three to guide subsequent treatments, according to CMS transmittal 8739 to its Medicare Claims...
Medicare no longer requires facility certification for bariatric surgery
January 30th, 2014 - Scott Kraft
Thanks to a recent tweak to Medicare policy, facilities are no longer required to be certified in order for bariatric surgery procedures to be covered, CMS announced in a recent transmittal modifying its National Coverage Determination (NCD) on the procedure. The change took effect September...

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