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
Coverage & Appeals
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
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
Lawsuit Challenges Unjust and Inefficient Medicare Appeals Process
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 reviewJune 5, 2014 - The Center for Medicare Advocacy filed a complaint in United … [Read more...] about Lawsuit Challenges Unjust and Inefficient Medicare Appeals Process
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!