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Home > Audio Learning Center > How to Prevent Medical Necessity Denials

How to Prevent Medical Necessity Denials

Date:Thursday, March 26, 2020
Time:EVENING PROGRAM @ 5 pm - 6:30 pm Central Time

Can't attend? Register anyway and we'll send you the recording.

Presented by: Maxine Collins, MBA, CPA, CMC, CMIS, CMOM

Webinar/Audio Conference FAQs

Back by popular demand – join us for this rebroadcast of a PMI favorite.

Is your practice receiving denials for medical necessity? Have you been checking for NCDs-LCDs and medical policies before you submit a claim? Has your appeal been denied because you failed to follow the carrier’s guidelines?

The Local coverage determination (LCD) by a MAC defines whether or not a service is covered. Medicare contractors develop LCDs when there is no National Coverage Determination (NCD) to ensure that services being paid for by Medicare are medically necessary, or if there is a need to clarify an existing NCD.

In 2018 CMS revised chapter 13 of the Medicare Program Integrity Manual which describes the LCD process. In response to the 21st Century Cures Act, the agency aimed to increase transparency, clarity, consistency, reduce provider burden. CMS instructed the MACs to remove codes from LCDs by January 1, 2020 and place them on billing and coding articles or policy articles published to the Medicare Coverage Database (MCD). These articles directly link to the LCD policy allowing coders to readily find the guidance needed on coding for claim submission of services related to an LCD.

Is your practice using the tools CMS has designed for you? Join this session to improve your knowledge and properly navigate carrier coverage determinations. Maxine will include a real-life example of the cost to the practice that bills and receives payment for items that are later audited and determined to be out of compliance with requirements in the coverage guidelines. Educate yourself and safeguard your providers’ reimbursement.

Continuing Education Units (CEUs)

PMI CEU APPROVED Earn 1.5 PMI CEUs for attendance at this program. Practice Management Institute grants CEUs for its certified professionals based on total number of instructional hours (1 CEU per hour of classroom instruction). CEUs may be applied to annual recertification requirements, as directed in the certification renewal requirements for your credential(s).

If you are seeking CEU credits for other certifications or organizations, please contact your organization for pre-approval and credit guidelines. A certificate of attendance will be provided.

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Sign up now and you'll receive this webinar plus the following benefits for as long as you subscribe: access codes to all upcoming live webinars and unlimited access to the TOTAL ACCESS Library, more than 300 hours of on-demand, pre-recorded training sessions on over 100 topics relevant to medical office coding, billing, compliance, management, front desk, and much more. It's a GREAT VALUE!

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About the Presenter

Maxine has more than 30 years of experience in medical practice management, adult education, and general business. She is the former administrator for a multi-specialty clinic, and has taught numerous practice management, accounting and business communications courses at various levels at Midwestern State University in Texas. She has extensive experience as a practice consultant and has taught both administrative and clinical personnel.

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