BCBS Nebraska Tightens MA Appeals and Cuts Radiology and Lab Reimbursement
BCBS Nebraska is updating the Medicare Advantage (MA) provider appeals process.
A coalition of more than 30 stakeholder organizations has written to key lawmakers expressing their support for the Timely Access to Coverage Decisions Act of 2026 (H.R. 8500).
In an Aug. 10 letter to Reps. Neal Dunn (R-Fla.), Nanette Barragán (D-Calif.), and Claudia Tenney (R-N.Y.), the undersigned organizations, including the College of American Pathologists (CAP) and American Clinical Laboratory Association, applaud the legislation, saying it “would help ensure that patients have access to medically necessary items and services by making the local coverage determination (LCD) process more predictable and meaningful by providing an open, transparent process and improving the Centers for Medicare & Medicaid Services (CMS) oversight of Medicare Administrative Contractors (MACs) coverage policies.”
The bill would require MACs to set defined timelines for both initial LCD requests and formal reconsideration. It would also require open public meetings with an agenda provided 14 days in advance and would require the LCD development process to incorporate input from physicians, patient representatives, and industry stakeholders (with a posted record of such meetings within 14 days). Finally, stakeholders would also have the option to appeal a final LCD to CMS after exhausting a MAC-led review, and the final LCD would be required to be a logical outgrowth of the initial draft LCD.
More than 90 organizations support the bill’s passage, according to a CAP press release.
Sources:
https://www.cap.org/wp-content/uploads/2026/08/LCD-Coalition-Final-letter-081026-1.pdf?download=true
BCBS Nebraska is updating the Medicare Advantage (MA) provider appeals process.
The Centers for Medicare & Medicaid Services (CMS) says it will continue to deny claims for duplicate laboratory services unless the tests are deemed...
The College of American Pathologists (CAP) submitted comments to the proposed 2027 Medicare Physician Fee Schedule (PFS), addressing proposals that...