Inconsistencies in Medicare Coverage Created by LCDs, OIG Reports

WASHINGTON (Jan. 9, 2014)—The Department of Health & Human Services Office of Inspector General (OIG) released a report on inconsistencies in Medicare Part B coverage created by local coverage determinations (LCDs). This study was not specifically related to DME. In fact, while DME Medicare administrative contractors (MACs) differ in their operational processes, LCDs specific to DME have been consistent among the MACs for many years.

The report explains that in 2011, more than half of Part B procedure codes were subject to an LCD in one or more states. Not only were the LCDs unrelated to the cost and utilization of items and services, they also limited coverage differently. In addition, LCDs defined similar clinical topics inconsistently.

OIG recommended that CMS establish a plan to evaluate new LCD topics for consistency with national coverage, continue efforts to increase consistency among existing LCDs and consider requiring MACs to jointly develop a single set of coverage policies. CMS concurred with all of OIG’s recommendations.