Medicare/Cms And Hyperbaric Oxygen Therapy Quiz

An NCD stands for National Coverage Determination, which refers to a decision made by the Centers for Medicare and Medicaid Services (CMS) regarding whether a specific medical service or item is covered by Medicare. This determination is based on evidence-based research and clinical guidelines to ensure appropriate and consistent coverage for beneficiaries.

A Medicare Administrative Contractor (MAC) is the new contracting entity that is responsible for the receipt, processing and payment of Medicare fee-for-service claims.

Just because Medicare pays for it does not mean that all private insurances will. Some only pay for acute osteomyelitis. Check the insurance company's "HBO Medical Policy".

Read the LCD (Page 5) http://hbotechblog.files.wordpress.com/2009/07/palmettogba_lcd.pdf

Medicare/CMS publishes the NCD (National Coverage Determinations). NCDs are policies that determine whether a particular item or service is covered by Medicare. Medicare/CMS is responsible for setting the guidelines and regulations for coverage and reimbursement under the Medicare program. They provide the necessary information and updates regarding coverage decisions to ensure that healthcare providers, beneficiaries, and other stakeholders are aware of the approved services and treatments.

To ensure that you have the correct up-to-date Medical Policy for HBOT from private insurance companies, you can follow multiple steps. Firstly, you can call the insurance company and request the Medical Policy for HBOT. Secondly, being persistent and making it sound urgent can help in obtaining the policy. Additionally, checking online to see if the policy is posted on the company's website can provide the necessary information. Lastly, looking at the date on the first page of the Medical Policy can confirm if it is up-to-date. Therefore, all of the above steps should be taken to ensure the correctness and up-to-dateness of the Medical Policy.

Unlike Medicare and the MACs, private insurance companies publish a "Medical Policy" for HBOT.

The primary responsibilities of each MAC (Medicare Administrative Contractor) are the following:
• Claims processing
• Beneficiary and provider customer service
• Appeals (in-case of denials)
• Provider education
• Financial management
• Provider enrollment
• Reimbursement
• Payment safeguards
• Information systems security

http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=20.29&ncd_version=3&basket=ncd%3A20%2E29%3A3%3AHyperbaric+Oxygen+Therapy

Claims for HBO for the treatment of diabetic wounds of the lower extremities require documentation of dual
diagnoses. An ICD-9-CM code from either the 249.70-279.71, 249.80-249.81, 250.70–250.73 or
250.80–250.83 range (representing a diabetes-related problem) and one of the following ICD-9-CM codes:
707.10 - Unspecified
707.12 - Ulcer of Calf
707.13 - Ulcer of Ankle
707.14 - Ulcer iof Heel and Midfoot
707.15 - Ulcer of other part of foot/toes
707.19 - Ulcer of other part of lower limb
CHECK YOUR LCD FOR FURTHER INFORMATION

MAC Contractors publish the LCD.

LCD's are losely based on the NCD's published by Medicare. NCD's always supercede LCD's (although LCD's contain a lot more detailed information).

86-75-309 definitely is not correct (although it's a great song). C1300 is the facility billing code for each 30 minutes of HBOT.

The correct code that the Physician bills Medicare for each session of HBO therapy is 99183.

There were a total of 15 MAC's awarded contracts by Medicare.

not-available-via-ai