tci Part B Insider - 2005 Issue 15

Coverage: CMS Wants Your Input On Coverage Process

Medicare will fine-tune coverage decision-makingNow is your chance to let the Centers for Medicare and Medicaid Services know how you think it should weigh evidence in deciding whether to cover an item or service.On April 7, the agency issued draft guidance to improve Medicare's National Coverage Determination (NCD) process using a new policy called Coverage with Evidence Development (CED). CMS will use the CED policy when a medical intervention lacks conclusive data supporting positive health outcomes or when sufficient data supports a medical intervention's effectiveness, but not medical necessity. CED could also answer questions about a medical intervention's...

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