Last week the Centers for Medicare & Medicaid Services released the Medicare premium, deductible and co-pay amounts for 2019. Below are the 2019 cost-sharing amounts.Part A Premium (For those not automatically enrolled)0-29 … [Read more...] about 2019 Medicare Cost-Sharing Announced
Coverage & Appeals
Re-Review of Some Home Health Denials Now Available
In January, Vermont Legal Aid and the Center for Medicare Advocacy settled a case on behalf of Medicare beneficiaries in the six New England states and New York who had had been denied coverage of home health services for not being … [Read more...] about Re-Review of Some Home Health Denials Now Available
Administrative Law Judges and Objective Medicare Appeals Jeopardized By Recent Executive Order
On July 10, 2018, the President signed an Executive Order undermining the impartial hiring of Administrative law Judges (ALJs). The order states that “conditions of good administration make necessary an exception to the competitive hiring rules … [Read more...] about Administrative Law Judges and Objective Medicare Appeals Jeopardized By Recent Executive Order
Congress DID Repeal Outpatient Therapy Caps Despite Lack of Information on Medicare.gov
The Bipartisan Budget Act of 2018 became law on February 9, 2018. The Act repealed the Medicare outpatient therapy caps, which functioned as a barrier to care for those receiving outpatient therapy services. Section 50202 of the Act, “Repeal of … [Read more...] about Congress DID Repeal Outpatient Therapy Caps Despite Lack of Information on Medicare.gov
Medicare Home Health Highlight
Home health access problems have ebbed and flowed over the years, depending on the reigning payment mechanisms, systemic pressures, and misinformation about Medicare home health coverage. Regrettably, as we’ve been reporting, it seems … [Read more...] about Medicare Home Health Highlight
Toolkit: Medicare Skilled Nursing Coverage and Jimmo v. Sebelius
Jimmo v. Sebelius, No. 11-cv-17 (D. VT), is a nationwide class-action lawsuit brought on behalf of Medicare beneficiaries who received care in skilled nursing facilities, home health care, and outpatient therapy and who were denied Medicare coverage … [Read more...] about Toolkit: Medicare Skilled Nursing Coverage and Jimmo v. Sebelius
Outpatient Therapy Caps: What Now?
Since the Balanced Budget Act of 1997, outpatient therapy under Medicare Part B has been subject to dollar limits, or caps.[1] During most of these 20 years, an “exceptions” process has allowed beneficiaries and providers to seek … [Read more...] about Outpatient Therapy Caps: What Now?
Issue Brief: CMS Issues New Rules Governing Medicare Appeals
CMS recently finalized significant changes affecting Medicare appeals, particularly at the Administrative Law Judge (ALJ) level of review. These changes apply to appeals of payment and coverage determinations for items and services furnished to … [Read more...] about Issue Brief: CMS Issues New Rules Governing Medicare Appeals
New Beneficiary Help Line for ALJ Appeals Results from CMA Litigation
Pursuant to the settlement agreement in Exley v. Burwell, a class action brought by the Center to address delays in appeals at the Administrative Law Judge (ALJ ) level, the Office of Medicare Hearings and Appeals (OMHA) has established a new help … [Read more...] about New Beneficiary Help Line for ALJ Appeals Results from CMA Litigation
GAO Report Highlights Certain Problems with Medicare Appeals
On June 9, 2016, the Government Accountability Office (GAO) publicly released a report (dated May 2016) titled “Medicare Fee-For-Service: Opportunities Remain to Improve Appeals Process”.[1] Among other things, the report … [Read more...] about GAO Report Highlights Certain Problems with Medicare Appeals