June 16, 2021

ACR Contractor Advisory Committee Network Meeting Reflects on Local Coverage Activities

The American College of Radiology® (ACR®) Contractor Advisory Committee (CAC) Network held its annual meeting June 8 to discuss local Medicare coverage activities. The virtual meeting was led by Sammy Chu, MD, FACR, Chair of the ACR CAC Network. Laeton Pang, MD, MPH, FACR, serves alongside Dr. Chu as the Radiation Oncology CAC Network Chair. The meeting included CAC representatives and alternates from each of the seven Centers for Medicare and Medicaid Services (CMS) Medicare administrative contractor (MAC) jurisdictions. The meeting participants included several newly appointed CAC representatives. CAC representatives are appointed by their state chapter.

CAC leadership spent a significant amount of time reviewing local coverage process changes and the evolving role of the CAC representative. Meeting participants spent time viewing critical elements of a local coverage determination policy, including coverage indications, limitations, medical necessity, provider qualifications, associated billing and coding articles, summary of evidence, and analysis of evidence that supports the MACs rational for coverage.

The meeting highlighted 2020–2021 local coverage policies, issues in radiation oncology, local coverage successes and challenges, and an open forum about CAC meetings and engagement with contractor medical directors throughout the year. There have been more than 15 local coverage determinations (LCDs) and 30 local coverage billing and coding articles that impact radiologists. Many of the topics have focused on spine interventions, allowing the ACR and our designated CAC representatives to work with spine intervention societies and experts to ensure fair reimbursement policies.

CAC Network leadership is concerned that CMS is minimizing the role of the CAC by contributing to a lack of transparency in the selection of clinical topics and subject matter experts before the release of draft LCD policy to the public. Many of the LCDs and CAC meetings have crossed multiple MAC jurisdictions, leading to more national coverage discussions on local and regional matters.

Feedback shared with the ACR suggests that more aggressive outreach is needed to engage with MACs. Many suggest engaging with CMS to address limitations of the revised LCD process and suggest improvements to engage physician volunteers in a more transparent way. Many of our veteran CAC representatives believe an Informal Medicare Physician Advisory Council (IMPAC) meeting should be held by each MAC to strengthen communication and collaboration between the physician community and the medical directors at the regional level. Currently, only the Noridian jurisdictions plan for these meetings at the request of their CAC representatives.

The network is committed to identify, review and comment on draft LCDs, Medicare issues and Medicare reform initiatives, and the ACR has dedicated physician volunteers and staff to prioritize local and national coverage requests. The CAC network helps assure we have a community dedicated to the radiologist’s best interest and advocates for the implementation of appropriate policies.

To remain effective, we need active CAC representatives and liaisons engaged in this process. Through outreach to state chapters and updates to our network distribution list, we can accomplish much more.

If interested in joining the CAC network or learning more about its goals and priorities, please email Alicia Blakey at ablakey@acr.org.