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August 24, 2016 at 12:55 PM
Insurance agents, insurers, patients, doctors and others who hate how traditional Medicare managers decide what to cover now have a good chance to complain about the decisionmaking process.
The Centers for Medicare & Medicaid Services (CMS) is putting the information collection processes at the heart of the Medicare program’s national coverage determination system through a routine paperwork review.
The review covers only the paper forms, electronic forms and information-handling methods CMS officials use to run the determination system, not the underlying standards governing which medical service and devices Medicare should cover.
Related: 10 Medicare facts for agents who know everything
But members of the public now have a chance to give CMS advice about ways to make the determination system cheaper, easier or faster for them use, or for CMS to administer.
CMS estimates it gets about 200 requests for national coverage determination decisions every year. Recently, for example, Medicare program managers have been conducting a national coverage analysis for a proposed coverage determination process for gender reassignment surgery.
The Medicare coverage determination team formally accepted a request for a gender reassignment surgery coverage review in December, collected public comments for a month, posted a draft decision memo June 2, and collected public comments on the draft memo until July 2.
The determination team received 106 public comments before it posted the draft memo, including a reply from Kaiser Permanente favoring a national standard and complaints from anonymous consumers who said Medicare money could be better spent on other things.
The draft memo attracted 38 comments.
