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Proposed rule would give prior determinations of coverage

Physician Practice Advisor, August 31, 2005

A proposed rule published in the August 30 Federal Register would provide caregivers and patients with coverage determinations for certain services before the service is performed.

The rule would establish an initial pool of the top 50 physician services performed at least 50 times annually with the highest allowed average charges. The Centers for Medicare & Medicaid Services said that the pool might include more services in the future.

CMS proposed the rule because beneficiaries are often discouraged from obtaining the most expensive physician services when they are unsure of Medicare's contribution, according to the rule. Further, many of these services are inpatient procedures in which there is enough time to request a prior determination.

For the text of the proposed rule and information on how to comment, click here and retrieve page 51321.

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