Medicare Billings, Claims and Appeals

  • Do You Know How to Make Sense of Your Medicare Statements?

    By on September 15, 2015

    Statements about your Medicare coverage contain important information about the costs of medical care and prescriptions you have recently received. Below we explore 2 main types of Medicare statements: the Medicare Summary Notice (MSN) and the Explanation of Benefits (EOB). It is important to note that MSNs and EOBs are not bills. Rather, they...

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  • Review Medicare’s Coverage of Durable Medical Equipment & How to Use this Benefit

    By on September 8, 2015

    Durable medical equipment (DME) is equipment that helps you complete your activities of daily living. Wheelchairs, walkers, and home oxygen equipment are some examples of Medicare-approved DME. Most people need some kind of DME at least once during their lives. In this presentation, we will learn how Medicare DME rules work so that you...

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  • Hospital Transitions ~ Do You Know Your Discharge Rights?

    By on August 11, 2015

    Did you know that 1 in 5 hospital inpatients return to the hospital within 30 days of leaving? To make the transition from the hospital as smooth as possible for you or a loved one, learn about Medicare discharge planning requirements, appeal rights, and coverage of post-hospital care. Below are 3 tips, plus additional...

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  • What Happens When a Beneficiary is Marked as Dead but is Still Very Much Alive? ~ Importance of Advocacy

    By on June 12, 2015

    While many children engage in games of playing dead for a moment or two, few adults have the bizarre experience of being marked as deceased while they are still very much amongst the living. For an elder, this can pose a whole host of problems, particularly when it is a government entity linked to...

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  • Are You Eligible for a Re-Review of Past Denied Medicare Claims?

    By on May 12, 2014

    This short article provides a brief background on the Jimmo settlement followed by an overview of who is eligible for a re-review process of denied claims for skilled care, the timeline to apply, and a link for more information. Background on the Jimmo Settlement Agreement The Jimmo settlement of January 24, 2013 clarified that...

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  • Will the Therapy You Need be Covered?

    By on March 13, 2014

    Currently Medicare limits payment for outpatient therapy services at an annual dollar amount, commonly called “therapy caps.” For example, payment for occupational therapy is capped at $1,920 for 2014. If a beneficiary needs more services than the capped amount covers, the therapist can help the beneficiary request an exception through an “exceptions process.” The...

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  • Protect Your Durable Medical Equipment Benefits ~ Be Aware of Common Scams & Report Fraud

    By on February 6, 2014

    One of the biggest “avenues” of Medicare fraud is with suppliers of durable medical equipment (DME). Last February the Centers for Medicare and Medicaid Services (CMS) reported that two-thirds of the roughly $10 billion Medicare spent on the program were “improper” payments. While some of this is fraud and some is just errors in documentation,...

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  • Observation Status Issue Makes Evening News

    By on January 13, 2014

    The problem of beneficiaries being held in “under observation” while receiving hospital care is growing. It often leaves affected beneficiaries with unexpected, large and sometimes financially devastating bills. This is because when someone is in classified as “under observation,” the hospital bills Medicare for outpatient services instead of inpatient care, even though the care...

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  • What is a Medicare Administrative Contractor & Why Should I Care?

    By on September 26, 2013

    Are you a provider offering Medicare hospital and/or outpatient services? Are you applying to be a Medicare provider? Or are you a Medicare beneficiary filing an appeal? If you answered yes to any of the above questions, it is important you know who serves as your regional Medicare Administrative Contractor (MAC) and what a...

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  • Will Beneficiaries Bear Extra Medicare Costs Due to the Sequester?

    By on May 18, 2013

    Many people are talking about the sequester that went into effect March 1st and the myriad of cuts. While the news reports no cuts in Medicare benefits, a 2% payment cut to providers will be imposed. The assumption is that the payment cut will not affect beneficiaries, yet it is unclear if the cost...

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