By Gill Deford, Margaret Murphy, and Judith Stein Diagnosed three years earlier with Amyotrophic Lateral Sclerosis ("ALS," or otherwise known as "Lou Gehrig’s Disease"), 68-year-old Eileen Prendergast was suddenly informed by her home health agency … [Read more...] about How the 'Improvement Standard' Improperly Denies Coverage to Medicare Patients with Chronic Conditions – text of article printed in Clearinghouse Review, Vol. 43, No. 9-10, Jan-Feb. 2010
The Improvement Standard
Medicare for People with Chronic Conditions
People with chronic conditions and long-term illnesses are too often denied Medicare coverage on the grounds that they will not improve, need "maintenance services only," have "plateaued" or are "chronic and stable". Taken together, these reasons … [Read more...] about Medicare for People with Chronic Conditions
The "Improvement Standard" is a Barrier to Necessary Care
Mrs. P, 68 years old, was diagnosed with Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig's Disease) five years ago. She now needs a wheelchair, cannot stand on her own, needs assistance to move from bed to wheelchair, and is losing … [Read more...] about The "Improvement Standard" is a Barrier to Necessary Care
Illegal “Improvement Standard” for SNF Coverage Terminated
Over the years, contractors that review Medicare claims have denied coverage for Medicare services inappropriately on the grounds that the beneficiary's condition will not improve. The Center for Medicare Advocacy, through individual appeals and … [Read more...] about Illegal “Improvement Standard” for SNF Coverage Terminated