On December 9, 2009, the Centers for Medicare & Medicaid Services (CMS) issued final regulations for the Medicare Claims Appeals Process (Parts A & B combined) and for the application of certain appeals provisions to the Medicare … [Read more...] about CMS Issues Final Rules for Medicare Appeals
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CMS Issues Final Rules for Medicare Appeals
On December 9, 2009, the Centers for Medicare & Medicaid Services (CMS) issued final regulations for the Medicare Claims Appeals Process (Parts A & B combined) and for the application of certain appeals provisions to the Medicare prescription … [Read more...] about CMS Issues Final Rules for Medicare Appeals
Medicare Replacement Drug Demonstration Update
THE DEMONSTRATION PROJECT: The Medicare Modernization Act of 2003, authorized Medicare to pay for expensive medications, not generally covered under Part B, for 50,000 of approximately 500,000 eligible Medicare beneficiaries. A “lottery” … [Read more...] about Medicare Replacement Drug Demonstration Update
Serious Deficiencies in Nursing Facilities are Understated and the Problem May Get Worse
Nursing facilities that choose to participate in the Medicare or Medicaid programs, or both, must undergo an annual survey to determine their compliance with federal standards of care, which are called Requirements of Participation.[1] Facilities … [Read more...] about Serious Deficiencies in Nursing Facilities are Understated and the Problem May Get Worse
A Client Profile
One of our clients, Mrs. Brown, who has been living alone with Multiple Sclerosis and various related health problems since 1986. She is declining. Currently, she is essentially bed bound and has to rely on assistance from at least one other person … [Read more...] about A Client Profile
Machado v. Leavitt
No. 07-30111-MAP (D. Mass.), filed June 19, 2007 Final Update: December 24, 2009 Issue: Whether the failure of the Secretary of HHS and the Commissioner of Social Security to stop withholding premium payments for Part D when requested by … [Read more...] about Machado v. Leavitt
Goodbye POS, Hello LI NET: More Help for Dually Eligible People
In 2006 the Centers for Medicare & Medicaid Services (CMS) created the "Point-of-Sale Facilitated Enrollment" (POS) process, administered by WellPoint. The purpose of the POS is to assist people who are dually eligible for Medicare and … [Read more...] about Goodbye POS, Hello LI NET: More Help for Dually Eligible People
LI NET: More Help for Dually-Eligible People
In 2006 the Centers for Medicare & Medicaid Services (CMS) created the "Point-of-Sale Facilitated Enrollment" (POS) process, administered by WellPoint. The purpose of the POS is to assist people who are dually eligible for Medicare and … [Read more...] about LI NET: More Help for Dually-Eligible People
Medicare Discharge Planning: Think Through Your Needs
Introduction Discharge planning[1] is an important tool for reviewing and making arrangements for on-going healthcare needs across healthcare settings, including hospitals, skilled nursing facilities, home health, or hospice. When focusing on … [Read more...] about Medicare Discharge Planning: Think Through Your Needs
Medicare for People with Chronic Conditions
People with chronic conditions and long-term illnesses are too often denied Medicare coverage on the grounds that they will not improve, need "maintenance services only," have "plateaued" or are "chronic and stable". Taken together, these reasons … [Read more...] about Medicare for People with Chronic Conditions