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?
Will the Therapy You Need be Covered?
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?
Protect Your Durable Medical Equipment Benefits ~ Be Aware of Common Scams & Report Fraud
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
Observation Status Issue Makes Evening News
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
What is a Medicare Administrative Contractor & Why Should I Care?
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 MAC does. Which regional MAC covers … [Read more...] about What is a Medicare Administrative Contractor & Why Should I Care?
