In order to manage costs, Medicare Advantage (MA) plans are able to restrict their enrollees to a contracted network of health care providers that is “sufficient to provide access to covered services to meet the needs of the population served.”* Some … [Read more...] about Advocacy Tip for Medicare Advantage Enrollees Facing Difficulty Obtaining In-Network Care
Self Help Packet
New from the Center: Form to Contest Multiple Medicare Denials Issued by Medicare Advantage Plans
During the past year, the Center for Medicare Advocacy has received an alarming increase in complaints from Medicare Advantage enrollees who, despite requiring skilled nursing facility (“SNF”) care, receive Notices of Medicare Non-Coverage (“NOMNCs”) … [Read more...] about New from the Center: Form to Contest Multiple Medicare Denials Issued by Medicare Advantage Plans
Home Health Practice Guide with Case Study (January 2020)
Medicare Home Health Coverage and CareIs Jeopardized By the New Payment Model –The Center for Medicare Advocacy May Be Able to HelpActual Recent Case StudyMrs. Green has advanced multiple sclerosis. She spends her time either in bed or in a … [Read more...] about Home Health Practice Guide with Case Study (January 2020)
Jimmo “Improvement Standard” Appeal Letter Template
[Date][Attorney’s Name] [Address]Re: [Beneficiary’s Name], Medicare No. [XXXXX]To Whom It May Concern:I am writing on behalf of my client, [Full Name], to request an expedited reconsideration. The skilled nursing facility (SNF) … [Read more...] about Jimmo “Improvement Standard” Appeal Letter Template
Medicare Fully Informed Project
Providing Medicare Beneficiaries with Complete, Objective Information to Help Them Make the Best Enrollment DecisionThe Center for Medicare Advocacy and the National Committee to Preserve Social Security and Medicare partnered on an education … [Read more...] about Medicare Fully Informed Project
Medicare Home Health Coverage Booklet
WHAT IS NEEDED TO QUALIFY FOR MEDICARE HOME HEALTH COVERAGE?The patient must be homebound. (This does not mean the patient can never leave home. For example, patients can leave home occasionally, go to adult day care, religious services, … [Read more...] about Medicare Home Health Coverage Booklet
Cobertura De Medicare Para Salud Domiciliaria
¿QUÉ SE NECESITA PARA CALIFICAR PARA COBERTURA DE SALUD DOMICILIARIA DE MEDICARE?El paciente debe ser confinado. (Esto no significa que el paciente nunca puede salir de su hogar. Por ejemplo, los pacientes pueden salir del hogar … [Read more...] about Cobertura De Medicare Para Salud Domiciliaria
Checklist for Medicare Nursing Home “Improvement Standard” Denials
With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Checklist to help Medicare beneficiaries and their families respond to unfair Medicare denials for skilled nursing facility care based on an … [Read more...] about Checklist for Medicare Nursing Home “Improvement Standard” Denials
Checklist for Medicare Home Health Care “Improvement Standard” Denials
With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Checklist to help Medicare beneficiaries and their families respond to unfair Medicare denials for home health care based on an erroneous … [Read more...] about Checklist for Medicare Home Health Care “Improvement Standard” Denials
Self-Help Packet for Outpatient Therapy Denials Including “Improvement Standard” Denials
Introduction Checklist for Outpatient Therapy Discharges Checklist for Outpatient Therapy Appeals Quick Screen: Medicare Coverage for Outpatient Therapy Outpatient Therapy Appeal Details Additional Information1. Introduction Dear … [Read more...] about Self-Help Packet for Outpatient Therapy Denials Including “Improvement Standard” Denials