Who Reviews the Reviewers?

Abstract

The Medicare program was enacted by Congress to provide needed health coverage for our senior citizens. According to Annette Kasabian of the Health Care Financing Administration of Boston, in the New England region, medical information submitted to a Medicare fiscal intermediary is reviewed by a registered nurse who makes the initial coverage determination, following the guidelines in Medicare's Intermediary Manual.1 These guidelines, however, are subject to an overriding rule of the Medicare program stipulating that the care rendered be reasonable and necessary, and the reviewing nurse makes this determination. Cases in doubt may be referred to a Medicare consultant . . .