PMID- 15786857
OWN - NLM
STAT- MEDLINE
DCOM- 20050429
LR  - 20061115
IS  - 1088-0224 (Print)
IS  - 1088-0224 (Linking)
VI  - 11
IP  - 3
DP  - 2005 Mar
TI  - Variation in Medicare's local coverage policies: content analysis of local 
      medical review policies.
PG  - 181-7
AB  - OBJECTIVE: To assess variation in the content of Medicare's local medical review 
      policies. STUDY DESIGN: Six case studies to compare differences in coverage 
      policies by diagnosis codes, procedure codes, and indications for use. METHODS: 
      All carrier policies from 48 carrier contracts (n = 5213) posted to the Centers 
      for Medicare & Medicaid Services Web site were downloaded on May 31, 2001. All 
      policies in the data set were coded based on a typology: new technology (NT), 
      extensions of new technology (TE), and utilization management (UM) of widely used 
      procedures. We identified policies addressing the same procedure or technology. 
      We required at least 20 separate policies in each case study to allow meaningful 
      comparisons. We randomly selected 1 case study of a diagnostic and 1 for a 
      treatment modality from each policy type (NT, TE, and UM). RESULTS: Given 
      previous research on local carriers, we expected to find variations among 
      policies in each case study. We found substantial similarity, however, among 
      policies covering the NT and TE types. We found significantly more variation 
      among our UM-type case studies. CONCLUSIONS: Medicare legislation has called for 
      greater coverage policy consistency in Medicare. This analysis on variation in 
      policy content, part of a larger study on variation in Medicare's local coverage 
      process, provides data on policy content differences. Policy reform should 
      reflect the nature of and reasons for policy variation as suggested by the 
      findings of this research.
FAU - Foote, Susan Bartlett
AU  - Foote SB
AD  - Division of Health Services Research and Policy, School of Public Health, 
      University of Minnesota, Minneapolis 55455, USA. foote003@umn.edu
FAU - Halpern, Rachel
AU  - Halpern R
FAU - Wholey, Douglas R
AU  - Wholey DR
LA  - eng
PT  - Case Reports
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am J Manag Care
JT  - The American journal of managed care
JID - 9613960
MH  - Humans
MH  - Insurance Claim Review/organization & administration
MH  - Insurance Coverage/legislation & jurisprudence/*organization & administration
MH  - *Medicare
EDAT- 2005/03/25 09:00
MHDA- 2005/04/30 09:00
CRDT- 2005/03/25 09:00
PHST- 2005/03/25 09:00 [pubmed]
PHST- 2005/04/30 09:00 [medline]
PHST- 2005/03/25 09:00 [entrez]
AID - 2820 [pii]
PST - ppublish
SO  - Am J Manag Care. 2005 Mar;11(3):181-7.