Home Health & Hospice

Know Your Local Coverage Determinations

Homecare Insider, February 6, 2012

Aside from the Conditions of Participation and the Medicare Benefit Policy Manual, the most important documentation for homecare providers to know are their Local Coverage Determinations (LCDs) and it’s surprising how many providers are not familiar with this information. With ADRs and other scrutiny on the rise, it’s essential that LCDs take precedence. LCDs are the mechanisms that determine Medicare coverage and the type of documentation required for payment. By simply going to the Medicare Administrative Contractor’s (MAC) website, agencies can access the LCDs that have been adopted and are utilized in processing claims.

Each LCD includes information that identifies the foundation of the LCD in regulation, indications for coverage, and limitations on coverage. It also provides coding information to support medical necessity and some even identify codes that do not support medical necessity. In addition, providers will find documentation requirements and utilization guidelines (if any exist). Some LCDs are very general. For example, Palmetto has adopted an LCD that describes coverage for physical therapy. Some are more specific; for example, Palmetto has an LCD describing teaching and training for Alzheimer’s disease.

Homecare administrators must ensure that agency staff who deliver care are familiar with LCDs. By accessing these, printing them, and distributing to clinical staff, agencies can help to ensure compliance.