Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

Coverage & Appeals

Center Attorneys Meet with Senate Finance Committee Staff Members About Changes to Medicare Appeals Process

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

Senate Finance Committee Holds Hearing on Medicare Appeals Backlog – Proposed Solutions Are of Great Concern

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.”[1] 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

Jimmo Class Members Can Now Have Their Coverage Denials Re-Reviewed

If you are covered by Medicare and you have a long-term or chronic condition, you may be eligible to have Medicare re-review your claims that were denied in prior years.  Please read carefully.In addition to revising Medicare manual … [Read more...] about Jimmo Class Members Can Now Have Their Coverage Denials Re-Reviewed

Advocacy Tips: Medicare Administrative Law Judge (ALJ) Hearing Process

1. First StepsReview the Center for Medicare Advocacy’s Self-help Packets and coverage guidelines regarding the particular level of care involved in the appeal at: https://www.medicareadvocacy.org.Watch for, receive and review the Medicare … [Read more...] about Advocacy Tips: Medicare Administrative Law Judge (ALJ) Hearing Process

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

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