tci Part B Insider - 2005 Issue 32

PRIOR DETERMINATION: More Certainty About High-Cost Items Could Be On Its Way

Your carrier has 45 days to decide on pricey items, but may respond more quicklyWhen patients sign an advance beneficiary notice (ABN) for big-ticket items or services, they're playing Russian roulette on Medicare's wheel. But soon you may be able to take the uncertainty out of it for your practice and your patients.The Medicare Modernization Act instructed the Centers for Medicare & 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...

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