Coming into my summer fellowship with the Center, I already knew that the Medicare program was complex. After my summer began, however, I soon realized that there are considerably more moving parts to the Medicare program than I had imagined. Over … [Read more...] about Mario Ramsey – Health Policy Intern
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Observation Status: Mixed Messages from Federal Government as Beneficiaries Continue to be Hurt
The use of “Observation Status” – treating certain hospitalized Medicare patients as outpatients when their care is indistinguishable from that of formally admitted inpatients – continues to garner considerable public and … [Read more...] about Observation Status: Mixed Messages from Federal Government as Beneficiaries Continue to be Hurt
August 2014 – Restructuring of Medicare’s Quality Improvement Organizations (QIO) & Other Issues
1. CHANGES TO MEDICARE’S QUALITY IMPROVEMENT ORGANIZATIONS (QIOs) CMS has restructured its Quality Improvement Organization (QIO) Program to separate the beneficiary complaint review functions from the quality improvement … [Read more...] about August 2014 – Restructuring of Medicare’s Quality Improvement Organizations (QIO) & Other Issues
Medicare Advantage Patient Bill of Rights Legislation Introduced in Congress
Medicare Advantage (MA) plans are increasingly dropping doctors and other health care providers from their contracted networks, often in the middle of a plan year, when most plan enrollees are not permitted to change plans. MA enrollees often … [Read more...] about Medicare Advantage Patient Bill of Rights Legislation Introduced in Congress
Hospice and Access to Medications Update: CMS Replacement Guidance
Quick SummaryWhen Medicare beneficiaries elect the hospice benefit, they waive Medicare coverage for all care and services related to the terminal illness that are not on the hospice plan of care and provided through the hospice provider. … [Read more...] about Hospice and Access to Medications Update: CMS Replacement Guidance
Ambulance Coverage
Quick Screen:When Should Medicare Coverage Be Available for Ambulance TransportationCoverage Criteria:Other Important Points: In non-emergency situations it is a good idea to ask whether the transportation will be … [Read more...] about Ambulance Coverage
June 2014 – Losing Your Voice: Medicare Coverage of Speech Generating Devices During Part A Stays & Other Issues
1. MEDICARE’S COVERAGE OF CAPPED RENTAL ITEMS DURING PART A INSTITUTIONAL STAYS: LOSING ACCESS TO SPEECH GENERATING DEVICES (SGDs)CMS Changes Its Coverage of Speech Generating DevicesThrough a new interpretation of longstanding … [Read more...] about June 2014 – Losing Your Voice: Medicare Coverage of Speech Generating Devices During Part A Stays & Other Issues
June 2014 – Medicare Coverage of Speech Generating Devices During Part A Stays & Other Issues
Welcome and Housekeeping (David Lipschutz, Moderator) Medicare’s Coverage of Capped Rental Items During Part A Institutional Stays: Losing Access to Speech Generating Devices (SGDs) (Alfred Chiplin) Overview of Medicare coverage … [Read more...] about June 2014 – Medicare Coverage of Speech Generating Devices During Part A Stays & Other Issues
April, 2014 – Ongoing Medicare Appeal Concerns & Other Issues
1. LITIGATION UPDATESJimmo v. Sebelius (Improvement Standard) No. 11-cv-17 (D.Vt. filed 1/18/11). As reported during previous Alliance calls, the Settlement in Jimmo was approved on January 24, 2013 during a scheduled fairness … [Read more...] about April, 2014 – Ongoing Medicare Appeal Concerns & Other Issues
Hospice and Access to Medications – New CMS Guidance
On March 10, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum to Part D Plan Sponsors and Medicare Hospice Providers entitled, "Part D Payment for Drugs for Beneficiaries Enrolled in Hospice – Final 2014 … [Read more...] about Hospice and Access to Medications – New CMS Guidance