tci Medicare Compliance & Reimbursement - 2004 Issue 38

Coverage: The Scoop On How CMS Makes Coverage Decisions

New guidance documents take some guesswork out of the NCD process.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:the necessary content, implications and relevant timelines...

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