Medicare Compliance & Reimbursement

Aggrieved beneficiaries get a fast track in updated Medicare coverage decision process. An overhauled method of issuing national coverage decisions could clear some of the murk from the process of securing Medicare coverage for new products and services. In a final rule published in the Sept. 26 Federal Register, the Centers for Medicare & Medicaid Services updates the process it will use to issue Medicare NCDs. Among the new policies: a separate process for beneficiaries who need an item or service that isn't currently covered. CMS says it will issue NCDs in such cases in 90 days. The rule also clarifies what elements are required to make a formal request for an NCD and outlines what CMS will consider in making its determinations. "Our goal is to make the latest advances in medical care available to Medicare beneficiaries more rapidly, while making evidence-based decisions that safeguard the health and safety of patients," says CMS Administrator Tom Scully. The rule goes into effect Oct. 27, 2003. To see the rule, go to http://www.access.gpo.gov/su_docs/fedreg/a030926c.html. Lesson Learned: Health care organizations that want to ensure that a new item or service gets covered under Medicare should look to CMS' Sept. 26 rule to make sure their coverage requests comply with all of the agency's requirements.