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 their health care benefits that got this important fact wrong. This scenario … [Read more...] about What Happens When a Beneficiary is Marked as Dead but is Still Very Much Alive? ~ Importance of Advocacy
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 Medicare’s maintenance coverage for skilled … [Read more...] about Are You Eligible for a Re-Review of Past Denied Medicare Claims?
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 exceptions … [Read more...] about Will the Therapy You Need be Covered?
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, this number shows that fraud … [Read more...] about Protect Your Durable Medical Equipment Benefits ~ Be Aware of Common Scams & Report Fraud
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 … [Read more...] about Observation Status Issue Makes Evening News