CAC Networks Assist With Local Medicare Issues

The ACR Carrier Advisory Committee Networks are responsible, in part, for ensuring that all appropriate clinical language explaining coverage and diagnosis codes are listed on a Local Medical Review Policy. Missing one key ICD-9 code can potentially cost radiology practices thousands of dollars in lost Medicare reimbursement, as well as leave patients without coverage for appropriate medical indications. With the support and assistance of the ACR CAC representatives, the ACR Radiology and Radiation Oncology CAC Networks have achieved great success in ensuring appropriate Medicare coverage and reimbursement at the local level:

Over 600 additional covered ICD-9-CM codes were added to the LMRP for MRI and CT scans of the lumbar, thoracic and cervical spine implemented by Noridian, the Medicare carrier in Alaska, Arizona, Colorado, Hawaii, Iowa, Nevada, North Dakota, Oregon, South Dakota, Washington and Wyoming.
Over 300 additional covered ICD-9-CM codes were added to the LMRP for MRA of the abdomen and chest implemented by National Heritage Insurance Company, the Medicare carrier in California.
Over 25 additional covered ICD-9-CM codes were added to the LMRP for external beam radiation therapy implemented by Empire, the Medicare carrier in New York and New Jersey.
Thirty-five additional covered ICD-9-CM codes were added to the LMRP for chest X-ray implemented by National Heritage Insurance Company, the Medicare carrier in California.
The Medicare carrier in Pennsylvania, HGSA, implemented an LMRP for brachytherapy that closely resembles the ACR/ACRa Radiation Oncology CAC Network model policy for brachytherapy.

In addition to ensuring that Medicare policies are appropriate, CAC representatives educate Medicare carriers on the practice of radiology and radiation oncology. For example, the ACR Vascular Ultrasound Accreditation Program was recognized on the Part B LMRPs implemented by the Medicare carriers in Arkansas, Oklahoma, Louisiana, eastern Missouri, New Mexico, North Carolina, Idaho and Tennessee. The program was recognized on the Part A LMRP for Mississippi, Missouri and Louisiana. These policies require accreditation for reimbursement, and without the inclusion of the ACR as an appropriate accrediting body, those with ACR accreditation would not be reimbursed for vascular ultrasound procedures.

We thank the CAC representatives for their hard work and dedication in ensuring that Medicare policies are appropriate and that Medicare carriers are educated. If you would like more specific information on ACR efforts on local Medicare issues, contact Kathryn Keysor at (800) 227-5463, ext. 4950, or kathrynk@acr.org.