tci Medicare Compliance & Reimbursement - 2005 Issue 36

Physicians: 'Prior Determination' System Premieres

Carriers have 45 days to decide on pricey items, but may respond more quickly.When patients sign an advance beneficiary notice for big-ticket items or services, they're playing Russian roulette on Medicare's wheel. But soon, physicians may be able to take the uncertainty out of it for their practices and their patients.The Medicare Modernization Act instructed the Centers for Medicare and Medicaid Services to come up with a prior determination process for "certain physicians' services," and the agency has finally stepped up. The CMS has unveiled its long-awaited "prior determination" system for the most expensive items and...

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