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?
Weekly Alert
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
Bundling Payments for Post-Acute Care
The traditional Medicare program pays individual health care providers for the specific services and care they provide to beneficiaries and guarantees that patients have “freedom of choice”[1] to select their Medicare providers. A … [Read more...] about Bundling Payments for Post-Acute Care
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
Medicare Takes a Big Step Forward to Help People Communicate – But There’s More to Do
Beneficiaries who seek Medicare coverage for expanded types and features of Speech Generating Devices (SGDs) have reason to be optimistic. Electronic devices that meet the definition of a Speech Generating Device will be coverable. This … [Read more...] about Medicare Takes a Big Step Forward to Help People Communicate – But There’s More to Do
Observation Status Update
Observation Status – hospital patients’ classification as outpatients, which makes them ineligible for Medicare Part A coverage of their subsequent stay in a skilled nursing facility (SNF) when they do not have “inpatient” … [Read more...] about Observation Status Update
Congress Passes “Doc Fix” – Senate Unable to Improve the Bill for Medicare Beneficiaries
On April 14, 2015, the Senate overwhelmingly (92 to 8) passed H.R. 2 – the Medicare and CHIP Reauthorization Act (MACRA) – which repeals and replaces the flawed Medicare physician reimbursement system known as the sustainable growth rate … [Read more...] about Congress Passes “Doc Fix” – Senate Unable to Improve the Bill for Medicare Beneficiaries
Medicare Myths vs. Facts – “Doc Fix” Edition
In the spirit of aiding the discussion concerning the budget and the SGR “Doc Fix,” we raise many of the myths surrounding Medicare and answer them with facts.Congress is working to repeal and replace the Sustainable Growth Rate … [Read more...] about Medicare Myths vs. Facts – “Doc Fix” Edition
Final 2016 CMS Call Letter for Medicare Parts C and D Released
Every year, the Centers for Medicare and Medicaid Services (CMS) issues payment, performance and other rules that apply to Medicare Advantage (MA) and Part D plans that choose to participate in the Medicare program in the following calendar year. … [Read more...] about Final 2016 CMS Call Letter for Medicare Parts C and D Released