June 25, 2020

ACR CAC Network Discusses Local Medicare Coverage Issues

On June 17, 2020, the American College of Radiology® (ACR®) Contractor Advisory Committee (CAC) Network held its annual meeting to discuss local Medicare coverage issues.

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. Special thanks to the CAC Network Immediate past chair, Robert Zeman, MD, FACR, for chairing the network for over 10 years. The College greatly values his dedication and commitment to coverage issues.

Many CAC members, appointed by their radiological state chapters, and representatives of the Radiology Business Management Association participated in the meeting. Based on an informal poll, 74% of meeting attendees have served as a CAC representative for 6–10 years. Attendees learned about recent changes the Centers for Medicare and Medicaid Services (CMS) made to the Local Coverage Determination (LCD) process, as well as priorities and expectations for CAC Network participants. We seek to engage the network in a new way and to increase the visibility of local coverage issues throughout the network and across the ACR.

The 2019 CMS changes to the LCD process and CAC structure allow for more participation and is not limited to two representatives per state or a particular specialty. We encourage representation across all modalities and specialty areas including diagnostic radiology, radiation oncology, nuclear medicine, interventional radiology and other imaging subspecialties.

The CAC provides a formal mechanism for healthcare professionals to be informed of the evidence used in developing LCDs and promotes communications between the Medicare Administrative Contractor (MAC) and the healthcare community. CAC members serve in an advisory capacity as representatives of their constituency to review the quality of the evidence used in the development of LCDs. There are seven MACs for 12 jurisdictions.

A top priority for the network remains the need to identify, review and comment on draft LCDs, Medicare issues and Medicare reform initiatives. By pursuing these priorities, the network helps assure the community that it represents radiology’s best interests and advocates for the implementation of appropriate policies.

During the meeting, attendees reflected on their experiences through the year with their local MACs. ACR staff and the CAC network have tracked the following local coverage topic areas for 2019–2020:

  • Percutaneous Vertebral Augmentation for Vertebral Compression Fracture
  • Non-Invasive Fractional Flow Reserve for Stable Ischemic Heart Disease
  • Magnetic Resonance-Guided Focused Ultrasound Surgery for Essential Tremor
  • Prostate Rectal Spacers
  • Computed Tomography Cerebral Perfusion Analysis
  • Non-Invasive Vascular Studies
  • 3-D Conformal Radiation Therapy Planning Services
  • Prior Authorization for Select Hospital Outpatient Department Services – Vein Ablation

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