In managing the LMRP process, CMS balances two competing policy goals--adaptation to local conditions and homogeneity in coverage decisions across geographic areas (Foote et al.
An example is new LMRP policies to address new uses of existing technologies, such as using MRI to diagnose Alzheimer's Disease, that do not fit within existing payment rules.
By October 1997, 26 model LMRPs
had been developed by carriers for payment of claims for laboratory tests.
Medicare contractors are required to develop and disseminate LMRPs
The product links users to the Web site of Medicare's fiscal intermediary, which manages the organization's LMRP
claims edits, and displays detailed information on the specific rejection codes.
The ability to automatically verify LMRP
in real time before the patient receives a specific treatment is going to make a significant improvement in both revenue recovery and efficiency for Dairyland's clients," noted Sheila Schweitzer, Chairperson and CEO of CareMedic Systems.
SoftMed's ClinTrac(R) APC Pro, a comprehensive management solution that delivers an enterprise view of the ambulatory payment classification coding process, will be the first SoftMed product to interface with CareMedic's LMRP content.
Facilities that choose to utilize APC Pro with the automated LMRP engine will have an easier time complying with Medicare's outpatient policies.
The company, which also provides extended billing office services to hospitals and other healthcare facilities, has developed a unique "one view" work list for its range of products and services, offering customers a single-view of their LMRP
compliance edits, EDI edits, and a real-time, virtual claim review by their Medicare Fiscal Intermediary, all prior to claim submission.
Powered by Info-X's EditEngine(TM) technology and utilizing the company's MedicalNecessity(TM) Dictionaries, Veri-Claim "scrubs" the charges to detect coding errors, missing charges, and LMRP
, NCD/LCD policy adherence.
Claims: Integration of Medicare CCI and LMRP
In some states, the carrier and FI agreed to have the same LMRPs
, but in many they differed.