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
Coverage & 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
Senate Finance Committee Approves Medicare Audit and Appeal Reform Bill
As we’ve previously reported, on April 28, 2015 the Senate Finance Committee held a hearing about the tremendous backlog of cases piled up at the Office of Medicare Hearings and Appeals (OMHA), the office that oversees Administrative Law Judges … [Read more...] about Senate Finance Committee Approves Medicare Audit and Appeal Reform Bill
The Medicare Dental Exclusion: Is it Being Used to Deny Vulnerable Beneficiaries Needed Care?
Government contractors administering Medicare benefits are routinely denying coverage to cancer patients for claims involving the surgical removal of decayed and infected teeth caused by an aggressive course of radiation treatment to the head and … [Read more...] about The Medicare Dental Exclusion: Is it Being Used to Deny Vulnerable Beneficiaries Needed Care?
Saga of an Inpatient Hospital Appeal: Notice and Use of Lifetime Reserve Days and Comments on Observation Status
This CMA Alert highlights a recent individual ALJ decision that sets out an important but often unrecognized beneficiary right to a written notice when he or she is about to use hospital “Lifetime Reserve Days.” A hospital’s … [Read more...] about Saga of an Inpatient Hospital Appeal: Notice and Use of Lifetime Reserve Days and Comments on Observation Status
Documenting Skilled Nursing Care for Medicare Coverage
June 10, 2015, 2:00pm - 3:00 PM ESTCost: $99.00 per siteThis webinar will examine proper documentation of skilled care for the purposes of obtaining Medicare coverage. The presentation will examine how to:Identify skilled care and … [Read more...] about Documenting Skilled Nursing Care for Medicare Coverage