Coding, Classification and Reimbursement

HELP! LCD and NCD education for lab

  • 1.  HELP! LCD and NCD education for lab

    Posted 27 days ago

    Hello!  

    I recently accepted a job as the compliance manager for a multi specialty clinic.  My background is primarily revenue and compliance, and my employer knew that when I started.  However, today my boss told me one of the priorities she would like me to work on is doing education and training for their lab.  Apparently, nobody has ever supplied our lab folks with updated LCD and NCD, nor does our EHR edit for them (although I have to assume we have capacity to create those edits).  

    So here is my question -  how should I go about this education short of giving them copies of LCD's and NCD's?  What do you do in your clinics?  Any HELP is appreciated.

    Thank you!

    Sarah



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    Sarah Jackson
    Compliance Manager
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  • 2.  RE: HELP! LCD and NCD education for lab

    Posted 27 days ago
    Congratulations and best wishes on your new job.

    I've used two different EHRs in my recent coding career (Meditech and Evident) and both had a medical necessity module.  I believe that type of module will provide more compliance than any LCD or NCD lists.  A challenge is getting the ICD-10 codes or the correct ICD-10 codes to input. I think our lab must use Google to find codes. I've had people ask for cheat sheets of codes but since you're not dealing with coders, that is not an avenue I endorse.  Another barrier has been buy in to the process.  Many lab personnel don't believe it should be part of their job so they don't do it or because of the high cost of some tests they feel bad for the patients if there isn't a code meeting medical necessity so the lab won't get an ABN signed but perform the test anyway. I don't think they realize how much that effects the organization's bottom line.
    We still query the ordering physician for a diagnosis for medical necessity even if the patient has signed that they will be financially responsible for the test.

    Hope that helps

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    Leslie Akam RHIA
    Him Coder
    Corry Memorial Hospital
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  • 3.  RE: HELP! LCD and NCD education for lab

    Posted 27 days ago
    Thank you so much, Leslie.  I will ask our applications folks if  we have a compliance module.

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    Sarah Jackson
    Compliance Manager
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  • 4.  RE: HELP! LCD and NCD education for lab

    Posted 26 days ago
    ​I used to create monthly provider brochures.  I found that handing an LCD to anyone not familiar with them is overwhelming. I focused first on our high volume tests or ones prone to denial.  One month may have been PSA's, another month urine cultures etc...  I included the test definition, some common known issues, diagnosis/symptoms that frequently warrants ordering the test and any other limitations, such as frequency, documentation requirements etc....  It was pretty effective.

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    Stacey Goodenough
    Manager of Medical Records / Privacy Officer
    Wayne Memorial Hospital
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  • 5.  RE: HELP! LCD and NCD education for lab

    Posted 19 days ago
    Thank you for all of the responses.  Right now, I'm looking at denials and using them to identify priorities.  I like the idea of doing provider brochures.

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    Sarah Jackson
    Compliance Manager
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