Beneficiary Satisfaction Measure is Not Used to It's Fullest ExtentUnlike report cards that use clinical measures, The Consumer Assessment of health care Providers and Systems (CAHPS) reports patient ratings of their experience with … [Read more...] about Consumer Assessment of Health Care Providers and Systems (CAHPS)
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Part Covered, Part Not: "Straddle Claims" in Medicare Part D
Medicare Part D coverage is complex, particularly when a prescription drug claim crosses multiple phases of the benefit. These "straddle claims" make it particularly challenging to determine what a beneficiary owes, but it is important to be … [Read more...] about Part Covered, Part Not: "Straddle Claims" in Medicare Part D
Part D And People Who Are “Medically Needy”
Warning: this Alert may cause headaches. Those readers who have ever roamed the Serbonian Bog[1] that is Medicaid will feel right at home. THE MEDICAID BOG The so-called Medically Needy - Medicare beneficiaries whose Medicaid eligibility depends on … [Read more...] about Part D And People Who Are “Medically Needy”
Medicare Cost-Sharing for Dual Eligibles: Who Pays What for Whom?
Guidance released recently by the Centers for Medicare & Medicaid Services (CMS) sheds new light on an issue that has created hardships for beneficiaries and challenges for advocates trying to help them. The guidance addresses two issues: balance … [Read more...] about Medicare Cost-Sharing for Dual Eligibles: Who Pays What for Whom?
Medicare Coverage of Power Mobility Devices: Tips and Reminders
When it comes to obtaining Medicare coverage for Mobility Assistive Equipment (MAE),[1] coverage criteria, particularly patient assessment standards, continue to be misunderstood by providers and beneficiaries. The spectrum of fraud and abuse … [Read more...] about Medicare Coverage of Power Mobility Devices: Tips and Reminders
Don’t “Fix” Medicare Out of Existence
Much of the current talk about the problems of Medicare misses the point. The proposals could end up "fixing" a successful program out of existence. Before supporting any fix, remember: Medicare has been a successMedicare assures the … [Read more...] about Don’t “Fix” Medicare Out of Existence
Weichardt v. Leavitt
WEICHARDT v. LEAVITT No. C 03-05490 VRW (N.D.Cal.), filed December 5, 2003 Updated: January 3, 2008 Issue: Whether CMS’ promulgation of final rules not requiring timely advance written notice to hospitalized Medicare beneficiaries who are … [Read more...] about Weichardt v. Leavitt
Healey v. Leavitt
No. 398CV00418 DJS (D.Conn.), filed March 4, 1998 Last Updated: September 21, 2007 Issue: Whether the Secretary of HHS failed to ensure that home health agencies provided sufficient notice and hearing rights to home health patients whose services … [Read more...] about Healey v. Leavitt
Addressing Concerns about Quality of Care For Medicare Beneficiaries
When beneficiaries receive Medicare coverable health care, there is an expectation that the provider will listen to their concerns and assess and provide appropriate medical care. What can beneficiaries do if they believe that the prescribed medical … [Read more...] about Addressing Concerns about Quality of Care For Medicare Beneficiaries
Webber v. McClellan
No. CV05-4219-PHX-NVW (D.Ariz.), filed December 22, 2005 Updated: April 5, 2007 Issue: Whether regulations issued by CMS on March 8, 2005, which, inter alia, establish a new cadre of ALJs to handle only Medicare claims and which make it virtually … [Read more...] about Webber v. McClellan