Understand Humana’s application of Medicare NCDs and LCDs
NCDs are established by the Centers for Medicare & Medicaid Services (CMS) and apply to claims nationwide. LCDs are established by each Medicare administrative contractor (MAC) and apply only to claims in each MAC’s region. To provide further billing guidance, MACs publish articles, which are beginning to replace LCDs. Typically, NCDs, LCDs and any related articles define coverage in terms of the appropriateness of a procedure for a certain diagnosis.
Humana’s online, on-demand presentation “Application of Medicare NCD/LCD Guidelines” explains how Humana applies NCDs, LCDs and articles to determine coverage for patients with Medicare Advantage. The presentation features easy-to-understand examples of how claims are processed based on NCDs, LCDs and articles. It has been updated recently to address the increased importance of articles in coverage determination.
You can access the “Application of Medicare NCD/LCD Guidelines” presentation, and many more, at Humana.com/MakingItEasier. Each presentation in the series discusses a specific claim-related topic and comes with a downloadable tip sheet or resource guides.