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 The Act repealed the Medicare outpatient therapy caps, which functioned as a barrier to care for those receiving outpatient therapy services.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
Coverage & Appeals
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
“Discharge” from a Skilled Nursing Facility: What Does it Mean and What Rights Does a Resident Have?
Skilled nursing facilities (SNFs) often tell Medicare beneficiaries and their families that they intend to “discharge” a Medicare beneficiary because Medicare will not pay for the beneficiary’s stay under either Part A (traditional Medicare) or Part … [Read more...] about “Discharge” from a Skilled Nursing Facility: What Does it Mean and What Rights Does a Resident Have?
Proposed Appeals Legislation Leaves Unanswered Questions
The Senate Finance Committee recently passed the Audit & Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015 (S. 2368). The Act, intended to improve the Medicare audit and appeals process, would not, in fact, improve the … [Read more...] about Proposed Appeals Legislation Leaves Unanswered Questions
Medicare Coverage of Skilled Care: Nine Services that are Skilled by Definition
The Center for Medicare Advocacy is concerned that Medicare beneficiaries are being denied Medicare coverage for skilled services that are specifically listed as covered by Medicare in federal regulations. Medicare covers various skilled therapies … [Read more...] about Medicare Coverage of Skilled Care: Nine Services that are Skilled by Definition