Nursing homes may deny admission to a Medicare beneficiary who needs expensive drugs, often as a result of financial concerns. Because of “consolidated billing,” nursing homes must pay for whatever medications, therapies, and services a resident in a … [Read more...] about Getting Chemotherapy While in a Nursing Home
Article
Reminder: Retrospective Observation Status Appeal Deadline is Jan. 2, 2026
Thanks to a successful class action lawsuit led by the Center for Medicare Advocacy, if you were hospitalized between January 1, 2009 and February 13, 2025 and reclassified from inpatient to “observation status,” you may have the right to file a … [Read more...] about Reminder: Retrospective Observation Status Appeal Deadline is Jan. 2, 2026
Know Jimmo | Outpatient Therapy to Maintain Function or Slow Decline Is Eligible for Medicare Coverage
The key to coverage is whether the individual requires a skilled provider to ensure the services are safe and effective, not whether improvement is expected.“Medicare coverage does not turn on the presence or absence of improvement from therapy, … [Read more...] about Know Jimmo | Outpatient Therapy to Maintain Function or Slow Decline Is Eligible for Medicare Coverage
CMS Rescinds Nursing Home Nurse Staffing Rule
The Centers for Medicare & Medicaid Services (CMS) repeals the 2024 nurse staffing rule, specifically, the numerical staffing requirements (3.48 hours per resident day, divided among various categories of nurses) and the requirement for … [Read more...] about CMS Rescinds Nursing Home Nurse Staffing Rule
Reminder – Open Enrollment Ends December 7th
Medicare Fall Open Enrollment ends December 7, so if you haven't reviewed your options for next year yet you still have a few days to make certain changes to coverage, including switching prescription drug plans or between traditional Medicare and … [Read more...] about Reminder – Open Enrollment Ends December 7th
When It Comes to Medicare Billing, It Pays to Be Persistent
Late last year, CMA was contacted to assist a beneficiary who was being billed over $10,000 from a Medicare-certified Skilled Nursing Facility (SNF). The family learned that the facility had not first submitted the claim to Medicare – for approval or … [Read more...] about When It Comes to Medicare Billing, It Pays to Be Persistent
CMA’s Toby Edelman Earns Advocacy Award
This week Center for Medicare Advocacy Senior Policy Attorney Toby S. Edelman was presented with a Special Lifetime Award from the National Consumer Voice for Quality Long-Term Care. The Award "honors a person who has dedicated their life to … [Read more...] about CMA’s Toby Edelman Earns Advocacy Award
CMA Welcomes Josh Norris as its New Litigation Director
The Center for Medicare Advocacy is pleased to welcome Josh Norris as its new Litigation Director.Josh brings three decades of dedicated legal advocacy on behalf of people with disabilities, equipping him with a thorough understanding of the … [Read more...] about CMA Welcomes Josh Norris as its New Litigation Director
Know Jimmo | CMS Reminder to MA Plans
In a February 2024 memo, the Centers for Medicare & Medicaid Services reminded Medicare Advantage organizations that Jimmo applies to them, saying that the Jimmo Settlement...clarified that the Medicare program covers skilled nursing care … [Read more...] about Know Jimmo | CMS Reminder to MA Plans
Happy Thanksgiving from CMA
Happy Thanksgiving, and thank YOU for being a part of the CMA community.The Thanksgiving holiday is the perfect opportunity to chat with family members and friends about Medicare coverage options - Medicare Fall Open Enrollment continues through … [Read more...] about Happy Thanksgiving from CMA