National Coverage Determinations (NCDs) are binding on all Medicare contractors, quality improvement organizations, health maintenance organizations, competitive medical plans and health care prepayment plans. The Secretary of the Department of Health and Human Services determines whether a particular item or service is covered nationally by Medicare, which essentially grants, limits or excludes national coverage to all Medicare beneficiaries.
However, 90 percent of Medicare policies are established at the local level, providing carriers with tremendous authority over payment policy in a given state. Representatives of the ACR Radiology, Radiation Oncology, and Nuclear Medicine Carrier Advisory Committee (CAC) Network advocate on behalf of radiology for fair reimbursement policies at the local Medicare level.
By reviewing and commenting on Local Coverage Decisions (LCDs) and proposed policy changes, the CAC networks help ensure that members are appropriately reimbursed for medically reasonable and necessary services provided to Medicare patients.