CMS revised a chapter in the Medicare Program Integrity Manual, which details policies and procedures for Medicare Administrative Contractors and provides guidance for stakeholder engagement.
Here's what you should know:
1. The revisions were made to chapter 13, which describes the local coverage determinations process.
2. CMS made changes in response to a provision of the 21st Century Cures Act designed to increase local coverage determination process transparency.
3. The revised manual includes:
- A step-by-step explanation of the local coverage determination process in accessible language
- A standardized summary of clinical evidence supporting local coverage determination decisions and the rationale behind MAC coverage determination
- The option to request an informal meeting with a MAC to discuss potential local coverage determination requests.
- A new process allowing interested parties in a MAC jurisdiction to request a new local coverage determination.
- Restructured Contractor Advisory Committee meetings with additional stakeholders involved
- Open meetings in the MAC jurisdiction to present proposed coverage and reasoning
- The retirement of proposed policies if not finalized within a year of the original posting date
- ICD-10-CM and CPT codes removed from local coverage determination in the future
- MAC responses to public comments linked to the final local coverage determination and stored in the Medicare Coverage Database indefinitely
- An local coverage determination reconsideration process consistent with the National Coverage Determination reconsideration process