The Center for Medicare Advocacy would like to highlight a recent legal development that may help enrollees and their families advocate for themselves when Medicare Advantage Plans prematurely deny Skilled Nursing Facility (“SNF”) care.In a … [Read more...] about New CMS Rule Helps MA Plan Enrollees Against Repeated SNF Denials in the Same Episode of Care
Coverage & Appeals
New Resources on Observation Status Appeals!
New year, new right to appeal. In 2025, as a result of the Center’s class action lawsuit, certain Medicare beneficiaries will have a new right to appeal their placement on “observation status” in hospitals. Information about these appeals is now … [Read more...] about New Resources on Observation Status Appeals!
Medicare Quality Improvement Organization Changes Name
Kepro is now Acentra HealthBeneficiary and Family-Centered Care Quality Improvement Organizations (BFCC-QIOs) help Medicare beneficiaries with their concerns about quality of care, and in filing an appeal if coverage is ending too soon. As … [Read more...] about Medicare Quality Improvement Organization Changes Name
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
Center for Medicare Advocacy Special Report | The Role of AI-Powered Decision-Making Technology in Medicare Coverage Determinations
Artificial intelligence (AI)-powered decision-making tools that are used in health care utilization management (UM) are increasingly used by providers and plans to automate the medical review and prior authorization processes, direct post-acute care, … [Read more...] about Center for Medicare Advocacy Special Report | The Role of AI-Powered Decision-Making Technology in Medicare Coverage Determinations
MA Plans Allowed to Report Less Data about Appeals Outcomes
CMS rolls back beneficiary protection in the name of reducing “MA plan burden” and making things “easy to read” for eligible beneficiariesThe most urgent and frequent type of call we receive at the Center for Medicare Advocacy is from a Medicare … [Read more...] about MA Plans Allowed to Report Less Data about Appeals Outcomes
Issue Brief: Medicare Payment vs. Coverage for Home Health & Skilled Nursing Facility Care
New Issue Brief: Medicare Payment vs. Coverage for Home Health & Skilled Nursing Facility CareThe Centers for Medicare & Medicaid Services (CMS) — the federal agency responsible for administering the Medicare program — has begun … [Read more...] about Issue Brief: Medicare Payment vs. Coverage for Home Health & Skilled Nursing Facility Care
2020 Medicare Cost-Sharing Rates Released
On November 8, 2019, the Centers for Medicare & Medicaid Services (CMS) released the 2020 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs.Each year, Medicare premiums, deductibles, and copayment … [Read more...] about 2020 Medicare Cost-Sharing Rates Released
Center Comments on Use of written Advance Beneficiary Notice of Noncoverage (ABN)
October 21, 2019VIA ELECTRONIC SUBMISSIONCenters for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-9115-P, Mail Stop C4-26-05 7500 Security Boulevard Baltimore, MD 21244-1850RE: … [Read more...] about Center Comments on Use of written Advance Beneficiary Notice of Noncoverage (ABN)
CMA Comments on “Patients Over Paperwork”
August 12, 2019SUBMITTED ELECTRONICALLY VIA www.regulations.govCenters for Medicare and Medicaid Services U.S. Department of Health and Human Services 7500 Security Boulevard Baltimore, MD 21244Re: CMS-6082-NC; Request for … [Read more...] about CMA Comments on “Patients Over Paperwork”