Awareness : OBC Tips

Proper Use of Medicare Coverage Analysis (MCA)

Medicare Coverage Analysis as a general guideline for use in determining which items and services are billable to Meidcare, patient and/or study. Such decisions are based on current benefit policies, coverage determination, coverage decisions, and federal guidelines.

All items and services that are billable to Medicare must be supported by medical necessity in the clinical documentation and are not limited to what appears on the MCA grid.

The clinical needs of the individual patient and the judgment of the clinical provider ultimately determine medical necessity.

The Medicare Coverage Analysis (MCA) is also known as a Coverage Analysis, Cost analysis, and/or billing grid.