LEGISLATIVE UPDATE 1.Senate Finance Committee Addresses Medicare Appeals System On previous Alliance calls, we have discussed that through the Center’s extensive experience with the Medicare administrative appeals process, we continue to … [Read more...] about June 2015 – Reforming Medicare’s Appeals System & Other Issues
Search Results for: oral health
The Medicare Dental Exclusion: Is it Being Used to Deny Vulnerable Beneficiaries Needed Care?
Government contractors administering Medicare benefits are routinely denying coverage to cancer patients for claims involving the surgical removal of decayed and infected teeth caused by an aggressive course of radiation treatment to the head and … [Read more...] about The Medicare Dental Exclusion: Is it Being Used to Deny Vulnerable Beneficiaries Needed Care?
Observation Status Update
Observation Status – hospital patients’ classification as outpatients, which makes them ineligible for Medicare Part A coverage of their subsequent stay in a skilled nursing facility (SNF) when they do not have “inpatient” … [Read more...] about Observation Status Update
April 2015 – The Potential Impact of the “Doc Fix” & Other Issues
LEGISLATIVE/BUDGET UPDATE 1.Medicare Physician Payment (SGR) In an effort to address the perennial issue of payment for Medicare physicians -- the fundamentally flawed reimbursement system known as the sustainable growth rate or SGR – the … [Read more...] about April 2015 – The Potential Impact of the “Doc Fix” & Other Issues
Center Comments on Proposed Rules for SNFs & ACOs
Centers for Medicare & Medicaid Services Submitted electronically, http://www.regulations.gov Re: CMS-1461-P Dear CMS Colleagues: The Center for Medicare Advocacy (Center) is pleased to provide the Centers for Medicare & Medicaid … [Read more...] about Center Comments on Proposed Rules for SNFs & ACOs
Federal Judge Rules Case to Fix Broken Medicare Appeals System May Continue
On January 29, 2015, a federal judge ruled that Medicare beneficiaries who filed suit about the lengthy and illegal delays in Administrative Law Judge appeals may proceed with the case. The Center for Medicare Advocacy, which represents the … [Read more...] about Federal Judge Rules Case to Fix Broken Medicare Appeals System May Continue
2015 Presenter Bios and Photos
Ben Belton Ben F. Belton is the Senior Advisor to the Acting Commissioner, Social Security Administration, Office of Intergovernmental and External Affairs. Prior to this he served as an HHS Constituency Liaison to constituency groups and … [Read more...] about 2015 Presenter Bios and Photos
Appeal Steps
Standard Appeals Process for Part A and Part B: 1. Redetermination No minimum claim amount Must be filed within 120 days of receipt of "Initial Determination" Filed with Medicare Contractor Reviewed and decided by … [Read more...] about Appeal Steps
December 2014 – The Year Ahead & Other Issues
LEGISLATIVE UPDATE The Year Ahead 1. Legislative & Budget Landscape in a New Congress In the 114th Congress staring in January 2015, Republicans will control both the House of Representatives and the Senate. What will this … [Read more...] about December 2014 – The Year Ahead & Other Issues
Prendergast v. Leavitt
No. 3:08-CV-1148 (AHN) (D.Conn.), filed July 31, 2008 Issue: Whether the use of a "stability" test to terminate home health coverage on the ground that the patient no longer needs skilled nursing care violates the Medicare statute and … [Read more...] about Prendergast v. Leavitt