1. First Steps Review the Center for Medicare Advocacy’s Self-help Packets and coverage guidelines regarding the particular level of care involved in the appeal at: … [Read more...] about Advocacy Tips: Medicare Administrative Law Judge (ALJ) Hearing Process
Coverage & Appeals
Expedited v. Standard Medicare Appeals: Not Knowing the Difference Could Cost You Your Appeal Rights!
Here’s the Issue Expedited Medicare appeals and standard Medicare appeals are designed to address different things and there are situations where a Medicare beneficiary must pursue both types of appeals. Expedited Appeals – … [Read more...] about Expedited v. Standard Medicare Appeals: Not Knowing the Difference Could Cost You Your Appeal Rights!
Special Report – Independence of Medicare Administrative Law Judges Threatened by Office of Inspector General’s Recommendations
In November, the Office of Inspector General (OIG) issued a report entitled, "Improvements are Needed at the Administrative Law Judge Level of Medicare Appeals." The report can be found at … [Read more...] about Special Report – Independence of Medicare Administrative Law Judges Threatened by Office of Inspector General’s Recommendations
Making Sense of Medicare’s Preventive Service Benefits
September 20, 2012 With the Balanced Budget Act of 1997 (BBA1997), Congress began an expansion of preventive benefits and services available through Medicare.[1] The Medicare Modernization Act of 2003 (MMA) added additional preventive … [Read more...] about Making Sense of Medicare’s Preventive Service Benefits
CMS Clarifies When the Advance Beneficiary Notice of Non-Coverage (ABN) Must be Issued
August 16, 2012 On June 1, 2012, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal No.R2480CP, which updates its instructions on the issuance of the Advance Beneficiary Notice (ABN), Form CMS-R-131.[1] The changes are … [Read more...] about CMS Clarifies When the Advance Beneficiary Notice of Non-Coverage (ABN) Must be Issued
New Medicare Summary Notice
On March 7, 2012, the Centers for Medicare & Medicaid Services (CMS) announced the redesign of the Medicare Summary Notice (MSN), the statement that informs Medicare beneficiaries about their claims for Medicare services and benefits. The … [Read more...] about New Medicare Summary Notice
The Medicare Advance Beneficiary Notice of Non-Coverage (ABN): A Tool for Limiting Beneficiary Liability
Medicare's limitation on liability (LOL) protections[1] apply when a provider believes that an otherwise covered Medicare item or service will be denied because the item or service is not reasonable and necessary[2] or is for custodial care.[3] … [Read more...] about The Medicare Advance Beneficiary Notice of Non-Coverage (ABN): A Tool for Limiting Beneficiary Liability
Court Emphatically Rejects Beneficiaries’ Right to Sue a Part D Plan When the Plan Delays Enrollment
In a lengthy, detailed, and complex decision, a federal appellate court rejected the right of Part D beneficiaries to sue a plan for damages when the plan fails to enroll them in a timely manner.[1] The decision, which was issued on August 31, 2010, … [Read more...] about Court Emphatically Rejects Beneficiaries’ Right to Sue a Part D Plan When the Plan Delays Enrollment
CMS Issues Final Rules for Medicare Appeals
On December 9, 2009, the Centers for Medicare & Medicaid Services (CMS) issued final regulations for the Medicare Claims Appeals Process (Parts A & B combined) and for the application of certain appeals provisions to the Medicare … [Read more...] about CMS Issues Final Rules for Medicare Appeals