Medicare Releases Guide On Requirements Of Approval

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Medicare beneficiaries and their health care providers may be able to take advantage of new advances in health care more quickly because innovators now have a new resource at their fingertips – a guide to Medicare affordable insurance coverage, coding, and payment issued by the Centers for Medicare & Medicaid Services (CMS).

The Innovator’s Guide to Navigating CMS, released today and available here, provides a roadmap to Medicare coverage, coding, and payment. This is the first time it has been presented in a single resource document.

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“Our aim is to provide the highest quality health care to people with Medicare and the tools to help them get that care,” said Acting Administrator Kerry Weems. “We now have the coverage, coding, and payment requirements that developers and technology innovators need in one place. This will help them to better navigate Medicare requirements by explaining how to make their products available to Medicare beneficiaries.”

In some cases, where a technological advance is groundbreaking, Medicare may need to make explicit coverage, coding or payment changes to ensure the coverage of reasonable and necessary new treatment options and the availability of medically appropriate technologies to its beneficiaries.

The guide was developed by the CMS Council for Technology and Innovation (CTI), a CMS-wide working group charged with streamlining and creating a more transparent process to get new technologies to patients more quickly. CTI is composed of senior CMS staff and clinicians, and was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

“This new guide is right in line with CMS’s efforts to make our operations transparent and accessible,” said CMS Deputy Administrator Herb Kuhn. “Like CMS’s new Web sites, Hospital Compare, Nursing Home Compare, and others, the Innovators’ Guide is a one stop shop for actionable information.”

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