Abstract
As providers, beneficiaries, device manufacturers, and other stakeholders strive to more fully understand the working parameters of the Medicare local coverage process, there is considerable value in presenting a more global, integrated approach. There are three major defining forces, which provide such a framework, and can be further exemplified by selected recent coverage case studies. These three forces are (1) specific regulatory mandates of the Medicare program, (2) the creation of stakeholder partnerships, and (3) the need to properly use medical evidence. Most coverage policies represent a combination of these forces. In fact, there is only the occasional local coverage scenario, which is characterized by the pure expression of any solitary element.
Any opinions expressed herein are those of the author and do not necessarily reflect the views of TrailBlazer Health Enterprises, LLCSM or Blue Cross Blue Shield of South Carolina. Further, any statements made concerning an identifiable product are those of the author and are not intended to be construed as either a favorable or an unfavorable recommendation of the product by TrailBlazer Health Enterprises, LLC or Blue Cross Blue Shield of South Carolina.
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Keywords
- Diabetic Macular Edema
- Retinal Nerve Fiber Layer Thickness
- Local Coverage
- Nucleic Acid Amplification Testing
- Medical Necessity
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Burken, M.I. (2006). Case Studies on the Local Coverage Process. In: Becker, K.M., Whyte, J.J. (eds) Clinical Evaluation of Medical Devices. Humana Press. https://doi.org/10.1007/978-1-59745-004-1_15
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