Medical Review

NHIC, Corp. DME MAC Jurisdiction A currently performs the following Medical Review (MR) functions.

• Performance of MR not for BI functions as outlined in MLN Matters article 5765 and the Medicare Program Integrity Manual (PIM), Chapter 5 - Items and Services Having Special DME Review Considerations;
• Comprehensive Error Rate Testing (CERT);
• Local Coverage Determinations (LCDs)
• Advance Determination of Medicare Coverage (ADMC);
• Healthcare Common Procedure Coding System (HCPCS);
• Medical Review not for BI Claim Edits;
• Probe Reviews;
• Supplier Education and
• Medical Review of Claims (not for BI purposes)

Bulletins

• Current
• Archived
• FAQs
• PCA

Medical Policies (Local Coverage Determinations(LCD))

• Current LCD
• Draft LCD
• Archived LCD
• LCD Reconsiderations
• LCD Related Documents
• Medicare Coverage Database
• How to Use The Medicare Coverage Database

HCPCS Codes / Modifiers

• 2009 HCPCS Jurisdiction List (306KB)
• 2008 HCPCS Jurisdiction List (129KB) (Effective Date 10/27/2008)
• Non-Covered Items (69 KB)
• Structure of HCPCS/Modifiers (17KB)
• HCPCS Modifiers (20KB) (Revised April 2010)
• HCPCS Codes:
  • A   (60KB)
  • B   (16KB)
  • E   (65KB)
  • J   (58KB)
  • K   (29KB)
  • L   (100KB)
  • Q   (16KB)
  • V   (25KB)
• DME Coding System (DMECS)

Benefit Integrity / Fraud

• Medicare Fraud Overview
• TriCenturion

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07/07/2010