tci Medicare Compliance & Reimbursement - 2003 Issue 40

Coverage: CMS SETS ITSELF DEADLINES FOR COVERAGE DETERMINATION

Beginning Oct. 27, Medicare national coverage determinations will follow newly defined tracks, with established deadlines, under a revised process announced in the Sept. 26 Federal Register. An NCD "is a national policy statement granting, limiting, or excluding Medicare coverage for a specific medical item or service." NCDs are binding on Medicare, its bill-paying contractors, Medicare health plans, and generally anyone who pays bills for or provides coverage for beneficiaries' care. One of two tracks for obtaining a new NCD is the so-called BIPA appeal, set up by Congress in the Benefits Improvement and Protection Act of 2000. Bipartisan...

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