Medicare's limitation on liability (LOL) protections[1] apply when a provider believes that an otherwise covered Medicare item or service will be denied because the item or service is not reasonable and necessary[2] or is for custodial care.[3] … [Read more...] about The Medicare Advance Beneficiary Notice of Non-Coverage (ABN): A Tool for Limiting Beneficiary Liability
Weekly Alert
Medicare Cost-Sharing for Qualified Medicare Beneficiaries
Balance Billing is Prohibited. Period. New Guidance released jointly by the Center for Medicaid and CHIP Services (CMCS) and the Medicare-Medicaid Coordination Office (MMCO) once again highlights and advises about an issue that has created … [Read more...] about Medicare Cost-Sharing for Qualified Medicare Beneficiaries
Voluntary Nursing Home Improvement Campaign Does Not Work
Nursing Facilities Participating in Advancing Excellence Still Among Worst Performers Many nursing facilities that are identified by the federal government as among the facilities providing the poorest quality of care to residents in the country … [Read more...] about Voluntary Nursing Home Improvement Campaign Does Not Work
New Medicare Part D Pharmacy Notice Rule In Effect; Stay Tuned for Final Model Notice
Effective January 1, 2012, Medicare Part D plan enrollees who are unable to obtain a prescription drug at the pharmacy are now, in most instances, entitled to a written notice explaining how they can contact their Part D plan in order to initiate an … [Read more...] about New Medicare Part D Pharmacy Notice Rule In Effect; Stay Tuned for Final Model Notice
Reminder: Medicare Covers Obesity Prevention with No Cost-Sharing
On November 29, 2011, CMS announced its decision to include coverage for obesity screening and counseling services for Medicare beneficiaries.[1] This new coverage for Medicare beneficiaries is another tool aimed at emphasizing prevention and … [Read more...] about Reminder: Medicare Covers Obesity Prevention with No Cost-Sharing
Payroll Tax Extension Includes Important Provisions for Medicare Beneficiaries
The payroll tax extension that finally became law on December 23, 2011 includes many provisions that will help Medicare beneficiaries and lower income families (Temporary Payroll Tax Cut Continuation Act of 2011, H.R. 3765; no public law number … [Read more...] about Payroll Tax Extension Includes Important Provisions for Medicare Beneficiaries
Special Focus Facility Study: Nursing Facilities’ Self-Regulation Cannot Replace Independent Surveys
Each month, the Centers for Medicare & Medicaid Services (CMS) identifies nursing facilities that are among the facilities providing the poorest care to their residents, as determined by federal deficiencies cited in the prior three … [Read more...] about Special Focus Facility Study: Nursing Facilities’ Self-Regulation Cannot Replace Independent Surveys
Fall Updates! Enrollment; Antipsychotic Drugs in SNFs; DME
Center Attorney Toby Edelman Testifies at Senate Aging Hearing About Overuse of Antipsychotic Drugs in Nursing Facilities Medicare Enrollment Period Ends December 7, 2011 January 2012 Brings Round 2 of CMS' Competitive Bidding … [Read more...] about Fall Updates! Enrollment; Antipsychotic Drugs in SNFs; DME
Forcing Dual Eligibles Into Private Health Plans is No Quick Fix
The nearly nine million Medicare beneficiaries who are also eligible for some form of Medicaid, the so-called dual eligibles, are the subject of federal, state and local policy discussions because many of them are among the highest users of health … [Read more...] about Forcing Dual Eligibles Into Private Health Plans is No Quick Fix
Supercommittee Update
With six days left until their November 23rd deadline, the Supercommittee has yet to reach a deal that meets its target of achieving $1.2 trillion in federal savings. Republicans on the panel tasked with reducing the deficit have indicated their … [Read more...] about Supercommittee Update