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5010 ANSI ASC X12N 837 PROFESSIONAL MHLA Data Specifications File Lacounty  Form

5010 ANSI ASC X12N 837 PROFESSIONAL MHLA Data Specifications File Lacounty Form

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Hello and welcome to another edition of Medicare Minute. I'm Dr. Robert Hoover, Medical Director at CGS Administrators, the Jurisdiction C DME MAC. Today, I'm going to talk about our policies and while I often say "DME policy", I'm really talking about local coverage determinations and the related policy articles. Some of you may remember back a decade or so ago when the DMERCs had local medical review policies or LMRPs. That all changed with the Benefit Improvement and Protection Act of 2000. Called BIPA for short, it required contractors to change the LMRPs and only include "reasonable and necessary" language in what became a local coverage determination or LCD. For the DME MACs, this created a dilemma. What do we do with all of the other stuff that didn't relate to reasonable and necessary provisions like coding guidelines and statutory restrictions? That's where the related Policy Article concept was born.

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