tci Part B Insider - 2004 Issue 42

Coverage Patchwork Caused By CMS Overwork

The fact that carriers have clashing policies for procedures such as ESWT comes from the fact that CMS is overstretched, says osteopath and consultant Douglas Jorgensen with Jorgensen Consulting in Manchester, ME. Medicare is leaving more and more decisions to the carriers, resulting in confusion, such as when carriers give wrong answers 90 percent of the time according to a recent GAO survey. (See PBI, Vol. 5, no. 30, p. 230.)  This scenario leaves providers exposed if they follow a carrier's teachings and then later a federal audit decides they billed incorrectly, Jorgensen complains. Also, having different...

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