Skilled nursing care and skilled therapy services for beneficiaries who need skilled care to maintain function or to prevent or slow decline is covered by Medicare. That is the message of reminders issued by the Centers for Medicare & Medicaid … [Read more...] about Jimmo Update: CMS Reminds Providers and Contractors of Medicare Coverage to Maintain or Slow Decline
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New Factsheet | Medicare Home Health Coverage and Jimmo v. Sebelius
Medicare home health coverage can be a crucial resource for individuals with long-term or chronic conditions who continue to reside in their homes. Beneficiaries who meet the qualifying criteria are eligible for home health coverage if the skilled … [Read more...] about New Factsheet | Medicare Home Health Coverage and Jimmo v. Sebelius
Medicare Covers Maintenance Therapy – Therapist Assistants Can Provide It
The Center for Medicare & Medicaid Services issued MLN Matters # MM-11721 on May 1, 2020. Effective January 1, 2020, the MLN, reconfirms that therapy to maintain an individual’s function is a Medicare-covered service. Further, the MLN authorizes … [Read more...] about Medicare Covers Maintenance Therapy – Therapist Assistants Can Provide It
Incorrect Implementation of the Jimmo V. Sebelius Settlement in a Skilled Nursing Facility: A Case Study
January 2020Download this Case StudyI. Background - The Jimmo SettlementIn 2013, a U.S. District Court approved the settlement agreement in Jimmo v. Sebelius,[1] requiring the Centers for Medicare & Medicaid Services (CMS) to confirm … [Read more...] about Incorrect Implementation of the Jimmo V. Sebelius Settlement in a Skilled Nursing Facility: A Case Study
Jimmo “Improvement Standard” Appeal Letter Template
[Date][Attorney’s Name] [Address]Re: [Beneficiary’s Name], Medicare No. [XXXXX]To Whom It May Concern:I am writing on behalf of my client, [Full Name], to request an expedited reconsideration. The skilled nursing facility (SNF) … [Read more...] about Jimmo “Improvement Standard” Appeal Letter Template
Expedited/Fast-Track Medicare Appeals in Skilled Nursing Facilities in Light of the Jimmo v. Sebelius Settlement Agreement *
BackgroundThe United States District Court for the District of Vermont approved a settlement agreement in Jimmo v. Sebelius[1] on January 23, 2013. The Jimmo Settlement required the Centers for Medicare & Medicaid Services (CMS) to confirm … [Read more...] about Expedited/Fast-Track Medicare Appeals in Skilled Nursing Facilities in Light of the Jimmo v. Sebelius Settlement Agreement *
Self-Help Resources for Improvement Standard Denials – August, 2019
Medicare coverage of skilled nursing and/or therapy services depends on a beneficiary’s need for the skilled care, not on the individual’s potential for improvement. The Settlement Agreement in Jimmo v. Sebelius, approved by a federal district court … [Read more...] about Self-Help Resources for Improvement Standard Denials – August, 2019
Medicare Coverage In Light of Jimmo v. Sebelius For Providers, Contractors, and Adjudicators
With support from The John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Fact Sheet to help Medicare providers, contractors, and adjudicators apply the correct legal standard to Medicare coverage and payment … [Read more...] about Medicare Coverage In Light of Jimmo v. Sebelius For Providers, Contractors, and Adjudicators
Jimmo Implementation: Beneficiary Successfully Appeals Denial of Maintenance Therapy
Despite the Jimmo case’s confirmation that Medicare coverage of a stay in a skilled nursing facility (SNF) is appropriate to maintain a resident’s functional status, when the nursing or therapy services must be provided by a professional … [Read more...] about Jimmo Implementation: Beneficiary Successfully Appeals Denial of Maintenance Therapy
Checklist for Medicare Nursing Home “Improvement Standard” Denials
With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Checklist to help Medicare beneficiaries and their families respond to unfair Medicare denials for skilled nursing facility care based on an … [Read more...] about Checklist for Medicare Nursing Home “Improvement Standard” Denials