Medicare Carriers, and LCDs, oh my!

Have you been to your Medicare Carrier’s website yet? Each state has a Medicare Administrative Contractor (MAC) with specific Jurisdictions. You should be familiar with it by now. If not, please go there today. You can find your Carrier by Googling your state name with “Medicare Part B” or going to the CMS link below:

https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Review-Contractor-Directory-Interactive-Map/

First item to research about your carrier, find your LCD or Local Coverage Determination. If you think all chiropractors in all states follow the same Medicare Guidelines, you are only half right! The Medicare Carriers determine the LCD by their own interpretation of the guideline. This is extremely important as of October 1, 2015. Unless you have been living under a rock, you know that we are using ICD-10 codes now and with that change came a brand new LCD. Make sure you know the codes you are allowed to use.

Second important item to know is your Carrier has an online portal. Whether you are a Participating or Non-Participating Provider, you can use their portal. It is a fantastic tool. You can get patient eligibility verification, duplicate remittance advice, submit corrections, submit re-determinations, check status of appeals, send a secure inquiry to the Carrier and receive a response within the portal.