The Center for Medicare Advocacy (CMA) recently helped Michigan schoolteacher Cara Bunnell successfully challenge her Medicare Advantage (MA) plan’s denial of prior authorization for a rolling shower chair prescribed by her physician.Ms. Bunnell … [Read more...] about Recent Victory in Appeal for Coverage of Rolling Shower Chair
Appeal Tips
When It Comes to Medicare Billing, It Pays to Be Persistent
Late last year, CMA was contacted to assist a beneficiary who was being billed over $10,000 from a Medicare-certified Skilled Nursing Facility (SNF). The family learned that the facility had not first submitted the claim to Medicare – for approval or … [Read more...] about When It Comes to Medicare Billing, It Pays to Be Persistent
Self-Help Packet for Skilled Nursing Facility Appeals Including “Improvement Standard” Denials
1. IntroductionThe Center for Medicare Advocacy has produced this packet to help you understand Medicare coverage and how to file an appeal if appropriate.Medicare is the national health insurance program to which many disabled individuals … [Read more...] about Self-Help Packet for Skilled Nursing Facility Appeals Including “Improvement Standard” Denials
Observation Status Appeal Resources
Disputes with Medicare Advantage Plans: Know the Difference Between Appeals and Grievances
Under Medicare law, Medicare Advantage plans and stand-alone Part D plans (“Plans”) must follow certain rules when enrollees disagree with Plan health care coverage determinations. Under the law, there are two distinct methods for raising issues with … [Read more...] about Disputes with Medicare Advantage Plans: Know the Difference Between Appeals and Grievances
Practice Tip: Office of Medicare Hearings and Appeals Manual Can Be a Useful Tool
The Office of Medicare Hearings and Appeals (OMHA) is the agency that administers the Administrative Law Judge (ALJ) hearing program for Medicare Parts A, B, C and D appeals. OMHA has a Case Processing Manual that sets out day-to-day procedures for … [Read more...] about Practice Tip: Office of Medicare Hearings and Appeals Manual Can Be a Useful Tool
Checklist for Medicare Nursing Home “Improvement Standard” Denials
With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Checklist to help Medicare beneficiaries and their families respond to unfair Medicare denials for skilled nursing facility care based on an … [Read more...] about Checklist for Medicare Nursing Home “Improvement Standard” Denials
Checklist for Medicare Home Health Care “Improvement Standard” Denials
With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Checklist to help Medicare beneficiaries and their families respond to unfair Medicare denials for home health care based on an erroneous … [Read more...] about Checklist for Medicare Home Health Care “Improvement Standard” Denials
Self-Help Packet for Outpatient Therapy Denials Including “Improvement Standard” Denials
Introduction Checklist for Outpatient Therapy Discharges Checklist for Outpatient Therapy Appeals Quick Screen: Medicare Coverage for Outpatient Therapy Outpatient Therapy Appeal Details Additional Information1. Introduction Dear … [Read more...] about Self-Help Packet for Outpatient Therapy Denials Including “Improvement Standard” Denials
Self-Help Packet for Home Health Care Appeals Including “Improvement Standard” Denials
Introduction Checklist for Home Health Appeals Quick Screen: Should My Home Health Care Be Covered By Medicare? Home Health Appeal Details Additional Information The “Improvement Standard” Myth and Home Health … [Read more...] about Self-Help Packet for Home Health Care Appeals Including “Improvement Standard” Denials