Medical Necessity and Utilization

LCD (Local Coverage Determination), NCD (National Coverage Determination) and LMRP (Local Medical Review Policy) define Medicare, Intermediary, and/or Insurance Carrier guidelines as to whether a specific procedure will be covered based on medical necessity and/or utilization (frequency).

MedUSA monitors these guidelines regularly updating information on procedures performed by our clients. Clients are notified as to changes in coverage criteria for procedures performed by practice; staff documentation and database reminders are also updated assisting staff during data entry to identify coverage issues.