What is the usual role of administrative law judges in relation to subordinate sources such as LCDs or MedLearn Matters?

Administrative law judges (ALJs) often consider local coverage determinations (LCDs) and resources like MedLearn Matters when making decisions on cases involving Medicare and healthcare claims. They usually follow these subordinate sources unless there is a specific conflict with higher laws or regulations. The rationale behind this practice is that LCDs and MedLearn Matters provide guidance that reflects the policies and standards set forth by the Centers for Medicare & Medicaid Services (CMS).

These documents help establish what services are covered and under what circumstances, facilitating consistency in the application of Medicare policies. When an ALJ encounters a situation, they will reference these guidelines to ensure that their decisions align with established practices. However, if prevailing laws or other higher regulatory determinations contradict an LCD or MedLearn Matter, the ALJ would then prioritize the higher authority. Understanding this hierarchical relationship is key in the auditing process and impacts decision-making regarding coverage and reimbursement issues.