The Jimmo case was settled in 2013, with an agreement, approved by the court, confirming that improvement potential is not the deciding factor to determine Medicare coverage for nursing home care, home health care, and outpatient therapy. The Jimmo … [Read more...] about Know Jimmo – Jimmo Can Open Doors to Necessary Care
Search Results for: Jimmo
Know Jimmo | Medicare Law and CMS Policy Spell It Out
The Code of Federal Regulations: “Restoration potential is not the deciding factor in determining whether skilled care is required. Even if full recovery or medical improvement is not possible, a patient may need skilled services to prevent … [Read more...] about Know Jimmo | Medicare Law and CMS Policy Spell It Out
Know Jimmo | When It’s Known, It Works
"My 92-year-old mother finally received payment this week related to her Second Level Appeal win against United Healthcare that was done by Livanta…my mother has now won 3 Medicare Appeals related to denial of skilled services received at a rehab/ … [Read more...] about Know Jimmo | When It’s Known, It Works
Know Jimmo | Payment Changes Did Not Change Coverage Criteria
(From CMS 2/20/2020) “Has Home Health Eligibility And Coverage Changed... No. While there has been a change to the case-mix adjustment methodology and the unit of payment beginning in CY 2020, eligibility criteria and coverage for Medicare home … [Read more...] about Know Jimmo | Payment Changes Did Not Change Coverage Criteria
Know Jimmo | Provider Education is Key
"I am a private nurse care manager who has advocated for my clients regarding the application of Jimmo decision for the last several years... without success. The therapists and nurses in the room continue to repeat 'Must discharge because of lack of … [Read more...] about Know Jimmo | Provider Education is Key
Know Jimmo | Medicare Home Health Coverage – Advocacy Tips
Download Our New Home Health Coverage Fact Sheet! … [Read more...] about Know Jimmo | Medicare Home Health Coverage – Advocacy Tips
Know Jimmo | Jimmo Applies to Medicare Advantage Plans
As far back as 2013, The Center for Medicare & Medicaid Services made it clear that the Jimmo Settlement applied to private Medicare Advantage plans. In a memo from April that year, announcing a new Jimmo Fact Sheet they stated: The goal of … [Read more...] about Know Jimmo | Jimmo Applies to Medicare Advantage Plans
Know Jimmo | Improvement is Not Required for Medicare Home Health Coverage
The decision regarding coverage should turn on whether skill is needed, not whether the individual is expected to improve. Maintenance nursing is a Medicare-covered service if a nurse is needed to provide or supervise care. Example: … [Read more...] about Know Jimmo | Improvement is Not Required for Medicare Home Health Coverage
Know Jimmo | Individualized Assessment Required
Longstanding federal law requires each Medicare determination to be based on the particular facts of the individual beneficiary’s condition and circiumstances. General norms based on algorithms, diagnoses, or other “rules of thumb” should not be the … [Read more...] about Know Jimmo | Individualized Assessment Required
Know Jimmo | Medicare Denials Due to Lack of Improvement are Contrary to Law
Long-standing Federal regulation makes that clear: “Restoration potential is not the deciding factor in determining whether skilled care is required. Even if full recovery or medical improvement is not possible, a patient may need skilled services … [Read more...] about Know Jimmo | Medicare Denials Due to Lack of Improvement are Contrary to Law