tci Medicare Compliance & Reimbursement - 2006 Issue 21

CMS: Speak Up To Keep Bad Local Policies From Spreading

Stop using the obsolete QV modifier for PET scans.If you like your carrier's Local Coverage Determination (LCD) for a particular service, now you can encourage Medicare to adopt it nationally. New LCDs may be eligible to become National Coverage Determinations starting on June 19, according to Transmittal 147, dated May 19. The Centers for Medicare & Medicaid Services will decide which LCDs to make into NCDs, based on: their net impact on clinical health outcomes, whether current national utilization patterns seem unreasonable or unnecessary, quality, access to care, and impact on the national Medicare payment error rate.In...

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