DEFINITIONS

LCD: A local coverage determination (LCD) is the new, official name for the local medical review policy (LMRP). LCDs are established by Medicare carriers and fiscal intermediaries to facilitate the review of Medicare claims by clarifying such things as which procedures (CPT codes) are covered for which diagnoses (DSM-IV codes) and what kind of documentation is required. LCDs are not intended to limit access to care provided under Medicare but merely clarify matters for providers and claims reviewers. Generally, LCDs are created only when there is some concern about the provision of the service the LCD covers. Medicare regulations provide a specific process for the development of new LCDs that calls for the involvement of all interested parties.

Medicare FI: A Medicare fiscal intermediary (FI) is the insurer that serves as payer for Medicare Part A (inpatient) claims. Most states have several FIs from which hospitals can choose.