Question

Policies developed by MACs to clarify coverage criteria for services or items not addressed by CMS are called which one of the following?

1) National Coverage Decisions
2) Local Coverage Decisions
3) Carrier Policies
4) Fiscal Intermediary Policies

Answer 1

Local Coverage Decisions (LCDs) are policies set by Medicare Administrative Contractors to clarify coverage criteria for services or items not covered by CMS directives, tailored to local healthcare environments.

Step-by-step explanation:

Policies developed by Medicare Administrative Contractors (MACs) to clarify coverage criteria for services or items not directly addressed by the Centers for Medicare & Medicaid Services (CMS) are called Local Coverage Decision (LCDs). These policies play a critical role in the operational functions of healthcare administration as they determine local medical practice within the MAC jurisdiction and offer specific coverage guidelines based on the regional healthcare environment. MACs address various services and items, including preventive services, surgeries, and medical equipment, ensuring that coverage aligns with the needs and standards of the local populations they serve.