Comment to Novitas by Lewis Black (CHAT)

Sidebar to this blog:

https://www.discoveriesinhealthpolicy.com/2023/09/acla-others-comment-on-verbose-and.html

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So, folks, gather 'round! We've got ourselves a letter here dated September 8, 2023, and it's a doozy. The medical directors got some mail, they received a letter from a bunch of big-shot organizations, and boy, are those guys concerned!

Why, you ask? Well, it seems these "Genetic Testing for Oncology" draft policies by Novitas and First Coast Service Options (FCSO) are about as clear as mud. And, if they're actually finalized, Medicare beneficiaries with cancer might as well kiss their access to genetic testing goodbye! And who needs that when they're in the middle of a cancer diagnosis, right?

But wait, there's more! These policies apparently don't play by the Social Security Act and Medicare Program Integrity Manual's rules. Shocking, I know. They're worried about this "default" non-coverage for tests that aren't in some "knowledgebases." Sounds pretty darn vague, doesn't it? And if a test isn't covered, well, tough luck, pal.

And don't even get them started on those pesky ICD-10 codes! Some codes mysteriously disappeared from the billing articles. Poof! Gone! If your code isn't there, tough cookies, because your test won't be covered. Who needs genetic testing anyway? It's overrated!

But the fun doesn't stop there. Brace yourselves, because there's a whole bunch of issues in this draft LCD. They're worried about "Documentation Requests" and the inevitable coverage limitations because doctors and labs can't seem to share information properly. Go figure!

And here's the pièce de résistance: genetic tests for hereditary cancer syndromes are limited to once in a beneficiary's lifetime. Yep, you read that right! Even if technology improves and we learn more, tough luck, Granny!

Now, as we all know, these folks don't believe Novitas and FCSO have followed the rules for an LCD. Apparently, you need to include a summary of the evidence when you make one of these things, but who's got time for that?

So, in true bureaucratic fashion, these organizations are begging, pleading, and practically getting down on their knees, asking Novitas and FCSO to pretty please fix these policies. Because, you see, they'd like Medicare beneficiaries to have access to essential genetic tests. What a novel idea!

So there you have it, ladies and gentlemen, a whirlwind tour of bureaucratic mishaps and healthcare concerns, all wrapped up in one delightful Lewis Black-style rant! Isn't the world just a fascinating place?