Self Help Materials

Self-Help Materials to Appeal your Medicare Denial

• Self-Help Packet for Skilled Nursing Facility Appeals Including “Improvement Standard” Denials
• Observation Status Appeal Resources
• Checklist for Medicare Nursing Home “Improvement Standard” Denials
• Checklist for Medicare Home Health Care “Improvement Standard” Denials
• Self-Help Packet for Outpatient Therapy Denials Including “Improvement Standard” Denials
• Self-Help Packet for Home Health Care Appeals Including “Improvement Standard” Denials
• Self-Help Packet for Hospital Discharge

Other Advocacy Tips

• Advocacy Tip for Medicare Advantage Enrollees Facing Difficulty Obtaining In-Network Care
• Home Health Practice Guide with Case Study (January 2020)
• Advocacy Tips: Medicare Administrative Law Judge (ALJ) Hearing Process
• Expedited v. Standard Medicare Appeals: Not Knowing the Difference Could Cost You Your Appeal Rights!
• Choosing Between Traditional Medicare and Medicare Advantage

Comprehensive Toolkits

• Toolkit: Medicare Home Health Coverage and Jimmo v. Sebelius
• Toolkit: Medicare Outpatient Therapy Coverage and Jimmo v. Sebelius
• Toolkit: Medicare Skilled Nursing Facility Coverage and Jimmo v. Sebelius

Our Self-Help Packets Work:

“I went to [the Center for Medicare Advocacy’s] website and downloaded the Improvement Standard Self-help Packet and discussed it with the family.  I was amazed at what happened next.  When we spoke with the social worker, she admitted, “I don’t know the Medicare regulations, I’ve never read them.”  The family was able to stand up for their mother’s Medicare benefits by outlining, point by point from the self-help packet, the reasons why she met the skilled nursing care coverage criteria.  The social worker quickly backed down from insisting that mother be moved out of the rehab bed within the next few days. She agreed to delay the decision to move the patient until after the follow-up appointment with the doctor a week later.

At the hospital, the family was able to effectively communicate with the doctor, and his orders did not change (no weight, PT & OT 4x per day).  To everyone’s relief, the patient is still in the rehab bed.  The extra 70 days in rehab will be covered by Medicare and the co-pay will covered by their supplement…this is a tremendous saving for this family.”

Tracey Keibler,
Executive Director, ApparentPlan
Public Policy Director, Minnesota Board on Aging