In September 2006, the nursing home industry announced a voluntary quality improvement campaign – Advancing Excellence in America’s Nursing Homes.[1] The campaign, now in its ninth year and third phase, describes its mission: “to make nursing homes … [Read more...] about Advancing Excellence: Very Few Nursing Homes are “Full Active Participants” and Nearly Half of Them Provide Poor Care
Weekly Alert
Non-Emergent Ambulance Transport: Don’t Lose Out on Coverage
Part B of Medicare will generally cover up to 80% of emergent and non-emergent ambulance transports when medically necessary and when transport by any other means could endanger your health. There are also origin/destination requirements; … [Read more...] about Non-Emergent Ambulance Transport: Don’t Lose Out on Coverage
Is the Movement for a Higher Minimum Wage Coming to Health Care?
Fast-food workers have been demonstrating for a higher minimum wage and recently, various corporations have increased the wages of their lowest-paid workers. Has the movement come to the health care industry?On May 22, 2015, the … [Read more...] about Is the Movement for a Higher Minimum Wage Coming to Health Care?
Senate Finance Committee Approves Medicare Audit and Appeal Reform Bill
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
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
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