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By A Medicare Beneficiary Having Medicare saved my life, and I will be forever grateful.  But I never thought of it before I was in the hospital, because I’d never really been sick. You have to fight for Medicare like your life depends on it.  Because, like me, your life may depend on it.  

This CMA Alert highlights a recent individual ALJ decision that sets out an important but often unrecognized beneficiary right to a written notice when he or she is about to use hospital “Lifetime Reserve Days.”  A hospital’s failure to provide appropriate notice in this context can lead to the waiver of a beneficiary’s liability for … Read more

By Matt Shepard My father worked his entire career for a private insurance company.  When he retired before he was 65, he and my Mom were able to remain in the HMO that his company had used.  The company was located in the next state over from my parents’ home state, and so was the network.  … Read more

The traditional Medicare program pays individual health care providers for the specific services and care they provide to beneficiaries and guarantees that patients have “freedom of choice”[1] to select their Medicare providers.  A current focus of Congress and policymakers is changing Medicare payment policy to pay, instead, for episodes of care for beneficiaries.  One issue … Read more

June 10, 2015,  2:00pm – 3:00 PM EST Cost: $99.00 per site This webinar will examine proper dcumention of skilled care for the purposes of obtaining Medicare coverage.  The presentation will examine how to: Identify skilled care and document it  to avoid the need for appeals; Provide adequate documentation of the patient’s condition whether changing … Read more

Medicare is a wonderful program.  It provides important health insurance for millions of older and disabled people. But, contrary to common belief, Medicare does not cover long-term care in skilled nursing facilities (often referred to as nursing homes).  In fact, at best, Medicare only covers up to 100 days of skilled nursing facility care per … Read more

The Medicare appeals system is not working. The success rate at the first two levels of appeal is staggeringly low for beneficiaries. It can take years to get an ALJ hearing decision – the third level of appeal, and the first real opportunity to get a coverage denial reversed. As we’ve previously reported, the Senate … Read more

Update: A new federal rule issued May 23, 2014, requires physicians, including psychiatrists and other prescribers of Part D drugs, to be enrolled in Medicare in an approved status or to formally opt out of Medicare to prescribe medications for their Part D patients. Since the publication of the final rule, however, CMS has learned … Read more

By Steve Gleason I was diagnosed with ALS four years ago.  Now I am unable to move my body, except for my eyes.  I communicate through technology called a Speech Generating Device (SGD).  The SGD allows me to maintain contact with the world around me – to express my thoughts, feelings and needs.  It allows … Read more

On April 28, 2015, the Senate Finance Committee held a hearing entitled “Creating a More Efficient and Level Playing Field: Audit and Appeals Issues in Medicare.”[1] As noted by Chairman Hatch in his opening statement, Medicare’s hiring of contractors to conduct audits of claims submitted to Medicare “has led to a seemingly insurmountable increase in appeals, with … Read more