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?
Coverage & Appeals
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
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
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
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?
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
June 10, 2015, 2:00pm - 3:00 PM EST Cost: $99.00 per site This 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
The Medicare appeals system is not working. The success rate at the first two levels of appeal is staggeringly low for beneficiaries. It can take years to get an ALJ hearing decision – the third level of appeal, and the first real opportunity … [Read more...] about Center Attorneys Meet with Senate Finance Committee Staff Members About Changes to Medicare Appeals Process
On April 28, 2015, the Senate Finance Committee held a hearing entitled “Creating a More Efficient and Level Playing Field: Audit and Appeals Issues in Medicare.” As noted by Chairman Hatch in his opening statement, … [Read more...] about Senate Finance Committee Holds Hearing on Medicare Appeals Backlog – Proposed Solutions Are of Great Concern
The Center for Medicare Advocacy’s 'Rubber Stamp' suit highlights the fact that 98% of Medicare appeals are denied at the first two levels of review June 5, 2014 - The Center for Medicare Advocacy filed a complaint in United … [Read more...] about Lawsuit Challenges Unjust and Inefficient Medicare Appeals Process