This week, President Obama unveiled his Fiscal Year 2015 Budget.[1] With respect to Medicare, it is very similar to last year’s proposed budget, both good and bad. One significant improvement over last year's budget is that it no longer seeks to alter the way the federal government measures inflation for purposes of paying Social Security benefits … Read more

On February 21, 2014, the Centers for Medicare & Medicaid Services (CMS) issued its draft 2015 Call Letter to Medicare Advantage (MA) and Part D plan sponsors, which includes a proposed rate for MA payment for 2015.[1]  Much anticipated, the draft Call Letter, which will be finalized in April, was preceded by an aggressive advertising … Read more

Final rules published in August 2013 by the Centers for Medicare & Medicaid Services (CMS) created time-based rules for determining inpatient status in an acute-care hospital.[1]  Under the rules' two-midnight presumption, a physician should order an inpatient admission if the physician expects that the patient's stay in the acute care hospital will be at least … Read more

On February 18, 2014, CMS’s Financial Services Group announced in an Alert an important change in the reporting threshold for certain liability settlements, judgments awards or other payments required by Section 202 of the Strengthening Medicare and Repaying Tax Payers Act of 2012 (SMART Act). CMS is increasing its current reporting threshold from $300 to $1000. … Read more

More than half a million Medicare beneficiaries rely on the Qualified Individual (QI) program to pay their Part B premium – a critical benefit afforded to older adults and people with disabilities with very low incomes and few assets. Reauthorization for the QI program is attached to the Medicare physician payment formula, known as the … Read more

Programs that help low-income people afford their Medicare, including the Medicare Savings Programs and the Part D Low Income Subsidy (also called LIS or Extra Help) have income and resource eligibility guidelines that change yearly. The Federal poverty level (FPL) guidelines for 2014 were published in the Federal Register on January 22, 2014.[1]  These guidelines … Read more

If you are covered by Medicare and you have a long-term or chronic condition, you may be eligible to have Medicare re-review your claims that were denied in prior years.  Please read carefully. In addition to revising Medicare manual provisions to now allow Medicare coverage for skilled maintenance care, the Settlement Agreement in Jimmo v. … Read more

As required by the 1987 federal Nursing Home Reform Law,[1] CMS has developed, tested, and periodically revised a survey protocol that state surveyors, who are generally employed by the state health departments, must use to determine nursing facilities' compliance with federal standards of care.  The survey protocol, which is composed of two Appendices to the … Read more

Medicare-covered outpatient physical, speech and occupational therapy services are subject to an annual dollar-amount payment cap.  As a result, many Medicare beneficiaries have their therapy terminate prematurely when they reach the cap.  While there is an Exceptions process in place that allows beneficiaries to receive therapy in excess of the caps, it is set to … Read more

Hospice is a program of care and support for people who are terminally ill.  To qualify for Medicare hospice coverage, a doctor certifies that a person is terminally ill, with an expectation of six months or less to live.  Once a person enters hospice, all their medical needs related to the terminal illness for pain … Read more