CMS has removed the Least Costly Alternative provision from all LCDs. Every LCD that has one of those provisions now has a new future version with an effective date of 02/04/11. The removal of the LCA provisions only applys to new rentals started on or after 02/04/11.
These policies are being written such that you appropriately bill for what the patient qualifies for only, otherwise the claim will be denied; there will be no automatic downcoding. This requires suppliers to use the free upgrade scenario or true upgrade provision (obtaining an ABN and charging for the difference) when providing something above and beyond what the patient qualifies for.
DMEPOS consultant Andrea Stark will be releasing an article clarifying what the removal of the LCA provisions mean, along with any other updates to the LCDS, in Vista Notes. Vista Notes is a bi-monthly news publication we release to keep suppliers informed of the latest Medicare changes. If you'd like more information on it, please let me know: michelle@miravistallc.com.
LCD- Elimination of Least Costly Alternative
Linear Mode
