Links to Medicare
Local Medical Review Policies
Local Medical Review Policies (LMRP's) set forth the policy of Upstate Medicare Division regarding payment for various medical services. Certain LMRP's govern several types of imaging examinations offered at Clifton Park Advanced Imaging. We make our best effort to comply at all times with the provisions of all Medicare rules and regulations, most especially those regarding medical necessity.
You may wish to consult other LMRP's relating to non-imaging services and procedures. The full range of LMRP's is available on our local Medicare carrier website:
http://www.umd.nycpic.com/lmrpcopy.html
USE DIAGNOSIS CODES APPROPRIATE FOR THE PATIENT’S CONDITION.
CODE ACCURATELY AND TO THE HIGHEST LEVEL OF DIAGNOSTIC CERTAINTY. DO NOT RESTRICT YOUR CHOICE OF DIAGNOSIS CODES (ICD-9-CM) TO THOSE APPEARING ON LMRP’s.
DO NOT INAPPROPRIATELY ADD OR CHANGE DIAGNOSIS CODES FOR THE PURPOSE OF OBTAINING REIMBURSEMENT FROM ANY GOVERNMENTAL PROGRAM OR COMMERCIAL INSURANCE CARRIER.
Diagnosis codes should reflect the highest level of your diagnostic certainty specific to the disease or condition that you are asking us to evaluate. In cases where a firm diagnosis has not yet been made, it is proper to use the patient’s symptoms and/or signs as the reason for the examination.
If an examination is requested for screening purposes, please indicate this to us directly so that we may properly advise your patient regarding his or her responsibility under some insurance contracts to pay out of pocket. Bear in mind that use of terms such as “rule out,” “suspected,” or “possible” may indicate that the requested examination is for screening purposes.