Key Medicare Coverage Principles
- Coverage turns on whether skilled care (nursing or therapy) is required.
- Skilled care is that which requires professional personnel to ensure the care is safe and effective.
- Skilled care to maintain the individual’s condition or slow decline is coverable.
- Restoration potential is not the deciding factor.
- Medicare should not be denied because an individual has a chronic condition or needs services to maintain his/her condition/function.
- An Individualized Assessment of each claim is required.
- Rules of thumb should not be used.
Search CMS.gov for Jimmo and An Important Message About Jimmo
Help Open Doors to Necessary Care!