The start date for Medicare administrative contractors (MACs) to expand coverage terms for patients in need of an implantable cardiac defibrillator (ICD) has been delayed a month, CMS said in a Feb. 26 policy update.
The policy update involves a revised national coverage determination (NCD) that governs who is eligible to receive an ICD to treat life-threatening heart disorders. CMS updated NCD 20.4 to widen eligibility parameters largely by removing the need for a patient to be enrolled in a clinical trial to attain coverage.
The update had been scheduled to take hold Feb. 26, but now the new date that it will take effect is March 26. That's when your MACs will be required to automatically recognize coverage for eligible patients.
As is the case with the original guidance, the revised coverage policies backdate to claims submitted after Feb. 15, 2018; that means, after the official implementation date of March 26, you will have to resubmit any claims that were denied on the grounds of the sunsetting coverage terms.