National Coverage Determination (
NCD) and Local
Coverage Determination http://www.cco.us/cco-yt
Alicia: Q:
Alright. We had a question come in through the forum that was really good; it's about NCD and LCDs. Now, with just that acronym, you're not going to know what that is, National Coverage Determination and Local Coverage Determination -- what are they and how are they used?
A:
It's actually not as difficult as you think to understand them, but it is a little confusing. This is not something you think about too awful much.
The National Coverage Determinations and the Local Coverage Determinations are decisions by Medicare and their administrative contractors that provide coverage information and determine whether services are reasonable and necessary on certain services offered by participating providers.
Now, I had a little breakdown of the
National, the steps that you get a national coverage. Its start out with the preliminary discussions, there you can see that in that box.
And then, it goes what's the benefit category, national coverage request, staff reviews it, they got a draft going, they get external assessments, they have an advisory committee, which those two words right there will tell you what coverage process that is.
Public comments, they have staff reviews. They can come up finally with final decision, and they have appeals board, if that doesn't go through. And then, it can go through reconsideration and all the way back to discussions again.
And look, this just one little area right here take
9 months, can take 9 months. It's not something that it's done quickly.
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- published: 10 Jul 2014
- views: 1757