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
Appeal Tips
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 Ambulance Appeals
1. Introduction Dear Medicare Beneficiary: The Center for Medicare Advocacy has produced this packet to help you understand Medicare coverage and to file an appeal if appropriate. Medicare is the national health insurance program to which … [Read more...] about Self-Help Packet for Ambulance Appeals
Self-Help Packet for Medicare “Observation Status”
Introduction How to Use This Packet Observation Status Self-Help Federal Regulations – Requirements for Medicare Coverage for Skilled Nursing Facility Care Pertinent Federal Regulations for Medicare … [Read more...] about Self-Help Packet for Medicare “Observation Status”
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 Information 1. … [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
Self-Help Packet for Hospital Discharge
Introduction Hospital Discharge Checklist Hospital Coverage Quick Screen Hospital Discharge Rights & Action Steps Glossary of Terms Federal Regulations Introduction The Center for Medicare Advocacy produced this packet to … [Read more...] about Self-Help Packet for Hospital Discharge
Self-Help Packet for Skilled Nursing Facility Appeals Including “Improvement Standard” Denials
Introduction Checklist for Skilled Nursing Facility (SNF) Appeals Quick Screen: Should My SNF Care Be Covered By Medicare? Skilled Nursing Facility Appeal Details Additional Information The “Improvement Standard” … [Read more...] about Self-Help Packet for Skilled Nursing Facility Appeals Including “Improvement Standard” Denials