tci Medicare Compliance & Reimbursement - 2003 Issue 43

Physicians: PHYSICIANS GET A BREAK ON APPEALS DOCUMENTATION

Long-delayed coverage appeal rule at last in final form.  Burdensome physician certification rules that could have derailed beneficiary appeals of Medicare coverage decisions have been stripped from the books. In a final rule governing beneficiary appeals of national and local coverage determinations, the Centers for Medicare & Medicaid Services relented on stringent certification requirements contained in its Aug. 22, 2002 proposal. Those requirements have been relaxed in the final rule: Now, certification that a service is necessary can simply be in the form of a written order or another component of the medical record. In addition, physicians won't...

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