Radiology among specialties supporting bill to speed up Medicare coverage decisions
Radiology is among multiple medical specialties endorsing a bipartisan bill to speed up coverage decisions under the Medicare program.
Providers and seniors often experience delays and administrative hurdles when seeking help through the local coverage determination process, which is plagued by inconsistent standards and a lack of transparency. House lawmakers are proposing the Ensuring Timely Access to Coverage Decisions Act in a bid to address this.
Co-sponsored by Reps. Neal Dunn, MD, R-Fla., Nanette Barragán, D-Calif., and Claudia Tenney, R-N.Y., H.R. 8500 would increase stakeholder involvement, require timely completion of requests, and create a process for reconsidering decisions. The American College of Radiology on Thursday signaled its support for the measure, calling it a “key ACR advocacy priority.”
“The college is committed to working with other healthcare organizations to improve the Medicare coverage process for physicians and patients,” the trade group said in a news update published Sept. 10.
To that end, ACR joined with over 30 other national healthcare organizations, who sent a letter to the three lawmakers, thanking them for their efforts. Those signing the message included the American Medical Association, American College of Emergency Physicians, and the College of American Pathologists, among others. They note that the measure would make the local coverage-determination process more predictable and meaningful by bolstering transparency.
It also would improve CMS oversight of Medicare Administrative Contractors’ individual coverage policies, they added. As a result of recent reforms, MACs are now responsible for much larger jurisdictions, often leaving fewer opportunities for physicians to interact with those who make local medical policies. ACR et al. noted that the process has for years been opaque, lacking sufficient stakeholder involvement to ensure decisions “are made in the best interests of patients.”
“Considering these challenges, it is imperative to ensure that timely coverage decisions are made by qualified health experts through a transparent process that is based on sound medical evidence. That is why H.R. 8500 is so important,” the doc groups wrote to the three co-sponsors in August.
Others signing the message included the Society for Cardiovascular Angiography and Interventions, Society for Vascular Surgery, the Association for Diagnostics and Laboratory Medicine, and several state pathology societies. Rep. Dunn, a trained urologist, also made his case for the measure back in April when it was introduced.
“Americans on Medicare too often face unnecessary delays and red tape in seeking coverage determinations for needed care,” Dunn said. “This bipartisan legislation will work to ensure patients receive timely coverage decisions and improve access to quality care.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.