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  • Welcome and Housekeeping  (David Lipschutz, Moderator)
  • Changes to Medicare’s Quality Improvement Organizations (QIOs) (Alfred Chiplin and Terry Berthelot)
    • Overview of QIO restructuring to separate the beneficiary complaint review functions from the quality improvement functions
  • Recent Revision to Hospice and Part D Guidance- (David Lipschutz and Terry Berthelot) 
    • CMS recently revised guidance that had served as a barrier to accessing drugs by requiring all prescribed medications for hospice patients that are billed to Medicare Part D to be initially denied coverage by being subject to prior authorization.   
  • Comparing Inpatient Rehabilitation Facilities (IRFs) vs. Skilled Nursing Facilities (SNFs): Implications for Medicare Payment Reform Proposals (Toby Edelman)
    • A recent study confirms that clinical outcomes for IRF patients are considerably better than clinical outcomes for SNF patients, but costs are higher for IRF patients than for SNF patients.  These findings have significant implications for site-neutral payment proposals and bundling demonstrations, both of which are likely to shift patients to SNFs. 
  • Oversight of the Competitive Bidding Process for Durable Medicare Equipment Prosthetics Orthotics and Supplies (Alfred Chiplin)
    • The Center is hearing of increased vendor dissatisfaction with the DMEPOS competitive bidding program, which we fear is translating into actions that create barriers to beneficiaries’ ability to get necessary DMEPOS items and services. 
  • Litigation and Medicare Appeals Update   (Gill Deford and Ali Bers)
    • Update on Medicare Appeals and ALJ Delay Issues
    • Jimmo – Improvement standard
    • Bagnall (Observation)
    • Other litigation
  • General Medicare Q&A (Moderator)
  • Wrap-up  (Moderator)
    • Keep informed: Myths and Truths, other information and updates on the Center’s Website
    • Next Call
  • REMINDER: Other information available at: https://www.medicareadvocacy.org/Projects/AdvocatesAlliance/AdvocatesAlliance.IssueBriefs.htm

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