Local Coverage Determination (LCD)

AMDA partners with state chapters to offer recommendations on the draft local coverage determination (LCD) covering physician evaluation and management services provided in the home and domiciliary setting.

AMDA has partnered with four states chapters (Minnesota, Illinois, Wisconsin, Michigan) to offer recommendations on the draft local coverage determination (LCD) covering physician evaluation and management services provided in the home and domiciliary setting (PHYS-081). Wisconsin Physician Services (WPS), which serves as the Medicare Part B carrier for the four states, issued the draft LCD drawing attention and criticism from AMDA members. Subsequently, the four state chapters sent a letter to Dr. Boren offering specific revisions to the draft LCD.

Edward Ratner, MD, President Minnesota Medical Directors Association says “Medicare Part B carriers should treat the medical house call, as a Medicare covered service, the same as similar services for similar patient in other settings. Carriers should require no additional documentation or justification for care of a frail beneficiary at home than would be needed to see such a patient in the office or nursing home.”

AMDA also has worked with the American College of Physicians (ACP) and the American Geriatric Society (AGS) to identify concerns with the draft LCD. The three national associations wrote to the Wisconsin Physician Services’ carrier medical director Stephen Boren, MD expressing similar concerns as the AMDA state chapters: the draft LCD reimburses home and domiciliary visits based on the frequency of visits and not medical necessity as required by Medicare. The letter states “if this draft LCD proposal is finalized, physicians will constantly fear that they are performing too many visits, because they would have no knowledge of how many visits would have been performed on this patient in the office setting.”

To view the letter to from state chapter please click here .
To view the ACP letter please click here .