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Case Studies on the Local Coverage Process

  • Mitchell I. Burken
Chapter
  • 1.1k Downloads

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.

Keywords

Diabetic Macular Edema Retinal Nerve Fiber Layer Thickness Local Coverage Nucleic Acid Amplification Testing Medical Necessity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Humana Press Inc., Totowa, NJ 2006

Authors and Affiliations

  • Mitchell I. Burken
    • 1
  1. 1.TrailBlazer Health EnterprisesLLCTimonium

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