Medicare Compliance & Reimbursement

CMS seeking feedback in effort to fine-tune NCD process.

Providers interested in being heard can give the Centers for Medicare and Medicaid Services their opinions on how it should weigh evidence in deciding whether to cover an item or service.

On April 7 the agency issued draft guidance to improve Medicare's National Coverage Determination (NCD) process using a new policy, called coverage with evidence development (CED).

CMS will use the CED policy when a medical intervention lacks conclusive data supporting positive health outcomes or when sufficient data supports a medical intervention's effectiveness, but not medical necessity. Don't Forget About Safety Questions CED could also answer questions about a medical intervention's safety, as well as risks and benefits to the Medicare patient demographic.

Watch for: CMS will hold an Open Door Forum on May 9 for public comment on many CED questions, such as:
  In what circumstances could a CED initiative be useful?
  What process should CMS use to decide when and how to apply CED?
  What study designs or evidence development methods should CMS use?
  How should CMS apply a study design and implementation process? Opportunity: Submit feedback online at caginquiries@cms.hhs.gov. The deadline for comment submissions is June 5.

To read the press release, go to www.cms.hhs.gov/media/press/release.asp?Counter=1423. For the complete draft guidance document, go to www.cms.hhs.gov/coverage/download/guidanceced.pdf.