CMS Meets to Discuss Coverage Policies and Physician Engagement

The American College of Radiology® (ACR®) Contractor Advisory Committee (CAC) Network and partners of a multi-specialty CAC engagement coalition met with Centers for Medicare and Medicaid Services (CMS) officials to address policy concerns with the local coverage determination (LCD) processes, the role of the CAC representative, and CAC meeting structure changes related to the 21st Century Cures Act.

With more than 40 participants, the meeting was intended to strengthen LCD processes and member engagement with Medicare Administrative Contractors (MACs). As ACR previously reported, CMS leadership acknowledged the importance of meaningful engagement with the provider community and the importance of ensuring local coverage policies are developed and updated in an inclusive, informed and transparent manner.

The meeting addressed three policy concerns:
• The need for meaningful opportunity for CAC Representatives to advise Contractors and CMS on coverage and billing Issues.
• The lack of public comment opportunities for local coverage articles that provide coding/billing guidelines.
• The need for transparent and objective processes for holding multi-jurisdictional meetings and selecting subject matter experts for panels.

The ACR and our coalition partners are working diligently to continue to have needed input into the LCD process so that all our patients can benefit. The LCD process is how CMS (Medicare) assigns appropriate language to provider service so that patients with the appropriate diagnoses can utilize this service with all the appropriate coding. We believe that a robust exchange of evidence-based literature, professional experience, and multispecialty input leads to the best outcomes in this process. This is why continued provider input to CMS and its private contractors is so vital.

The group communicated examples of areas for improvement based on examples from the specialty societies' experiences with the current LCD process. While saying it would take time to implement suggestions, CMS leaders acknowledge the viability of recommendations made in the coalition’s Principles for Sound Local Coverage Policies.

ACR will request a follow-up stand-alone meeting with CMS to delve deeper into recommendations.

If you have questions or would like more information about local coverage policies and activities, contact Alicia Blakey, ACR Principal Economic Policy Analyst.