Part B Insider (Multispecialty) Coding Alert

Coverage:

CMS Wants Your Input On Coverage Process

Medicare will fine-tune coverage decision-making

Now is your chance to let the Centers for Medicare and Medicaid Services know how you think 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On April 7, the agency issued draft guidance to improve Medicare's National Coverage Determination (NCD) process using a new policy called Coverage with Evidence Development (CED).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. 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: You can submit feedback online to CAGInquiries@ cms.hhs.gov. The deadline for comment submissions is June 5.

    To read the press release, go to http://www.cms.hhs.gov/media/press/release.asp?Counter=1423.

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