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 | Policy Center: Welcome
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| Welcome |
| CMS requires Regional Medicare Advantage Organizations, such as MedicareBlue PPO, to choose only one regional contractor for each area of Medicare coverage as its source for Local Coverage Determinations (LCDs) and to abide by all CMS National Coverage Determinations (NCDs) as well.
As required by CMS, MedicareBlue PPO has chosen LCDs from CMS contractors in Region 19 or developed its own criteria. Each area's criteria source is outlined below.
Part A - Noridian Administrative Services (NAS): Part A Hospital Insurance policies define the extent to which Medicare will help pay for inpatient hospital care, inpatient care in a skilled nursing facility following a hospital stay, home health care, and hospice care.
Part B - Wisconsin Physician Services (WPS): Part B Outpatient Insurance policies define the extent to which Medicare will help pay for care provided by certified medical facilities, such as hospital outpatient departments, renal dialysis facilities, and community health centers.
National Coverage Determinations (NCDs) - Center for Medicare and Medicaid Services (CMS): National Coverage Determination (NCD) policies define the extent to which Medicare will cover services, procedures, or technologies on a national basis.
RHHI - Cahaba Government Benefit Administrators: Regional Home Health Intermediary (RHHI) policies define the parameters in which Medicare beneficiaries certified as terminally ill may elect to receive hospice care under Part A instead of regular Medicare.
DME - Noridian Administrative Services: Durable Medical Equipment Medicare Administrative Contractor (DME MAC) policies define the parameters of how durable medical equipment, prosthetics, orthotics, and supplies are covered.
MedicareBlue PPO Medical Policy: MedicareBlue develops these policies in the absence of CMS guidance for a particular coverage topic.
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