Are you frustrated by national coverage determinations that seem to be decided behind closed doors? Reform bill provisions could shed some much-needed light on the decision-making process.
A notice in the Sept. 24 Federal Register says that the Centers for Medicare & Medicaid Services will soon make guidance documents available on its Web site. These resources will help providers get a handle on the key factors CMS looks at when determining whether an item or service is reasonable and necessary. This includes:
A word of caution from CMS: "The absence of a particular type of research (does not) necessarily result in a non-coverage decision, nor does submitting data from a particular type of study ensure coverage," the notice reads. "Each NCD involves unique factors that cannot be described explicitly in the guidance documents."
A public comment period will be set aside for each guidance document, which will be issued at
http://www.access.gpo.gov/su_docs/fedreg/a040924c.html.
Lesson Learned: Providers can expect a better understanding of - and have more voice in - CMS' NCD process.