GOVERNMENTMedicare ends routine Alzheimer's denialsClarification reflects the notion that Alzheimer's patients with dementia can benefit from Medicare services.By Markian Hawryluk, amednews staff. April 22/29, 2002. Washington -- With little fanfare, the Centers for Medicare & Medicaid Services confirmed that it had instructed Medicare carriers not to use computer edits to automatically deny claims for patients diagnosed with Alzheimer's disease. According to CMS Administrator Tom Scully, the move clarifies that Medicare may pay doctors and other health care professionals for neurodiagnostic testing, medication management and psychological therapy for patients with Alzheimer's disease. Previously, about 40% of Medicare carriers had been using coding edits to reject claims for treatment of patients with Alzheimer's and other types of dementia. The instructions were issued to carriers in September 2001, but CMS officials had not called attention to the change until recently. "Alzheimer's advocates came to us with what seemed to be a significant problem for Alzheimer's patients," Scully said. "Intuitively, this longstanding approach appeared to discriminate against Alzheimer's patients, and we were happy to fix it." The program memorandum said physicians and others submitting claims should provide the primary diagnosis of Alzheimer's, as well as the secondary diagnosis or condition that most closely reflects the medical necessity of the service for which the claim was submitted. CMS said claims submitted with only a diagnosis of Alzheimer's disease may entitle a beneficiary to evaluation and management visits and therapies if the contractor determines that the therapies are reasonable and necessary in the context of the patient's overall medical condition.
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