The Office of Medicare Hearings and Appeals (OMHA) is the agency that administers the Administrative Law Judge (ALJ) hearing program for Medicare Parts A, B, C and D appeals. OMHA has a Case Processing Manual that sets out day-to-day procedures for carrying out adjudicative functions, in accordance with applicable statutes, regulations, and OMHA directives. Importantly … Read more →

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 erroneous “Improvement Standard.” The Checklist outlines the coverage criteria for SNF care and emphasizes language from the Jimmo Settlement … Read more →

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 “Improvement Standard.” The Checklist outlines the coverage criteria for home health care and emphasizes language from the … Read more →

Introduction Checklist for Ambulance Appeals Quick Screen – Should My Ambulance Transport Be Covered By Medicare? Ambulance Transport Appeal Details Additional Information Glossary of Terms Medicare Regulations for Coverage of Ambulance Transportation Medicare Regulations Regarding Appeals Centers for Medicare & Medicaid Services Manual Provisions (CMS) Manual Provisions 1. Introduction Dear Medicare Beneficiary: The Center for … Read more →

Introduction How to Use This Packet Observation Status Self-Help Federal Regulations – Requirements for Medicare Coverage for Skilled Nursing Facility Care Pertinent Federal Regulations for Medicare Appeals INTRODUCTION Dear Medicare Patient: The Center for Medicare Advocacy has produced this Self-Help Packet to help you understand Observation Status and options for beneficiaries who are placed on … Read more →

Introduction Checklist for Outpatient Therapy Discharges Checklist for Outpatient Therapy Appeals Quick Screen: Medicare Coverage for Outpatient Therapy Outpatient Therapy Appeal Details   Additional Information 1. Introduction Dear Medicare Patient: The Center for Medicare Advocacy has produced this packet to help you understand Medicare coverage and how to file an appeal if appropriate. Medicare is the … Read more →

Introduction Checklist for Home Health Appeals Quick Screen: Should My Home Health Care Be Covered By Medicare? Home Health Appeal Details Additional Information The “Improvement Standard” Myth and Home Health Care Glossary of Terms Federal Regulations – Home Health Coverage Federal Regulations – Expedited Appeals Centers for Medicare & Medicaid Services (CMS) Home Health Manual Provisions … Read more →

Introduction Hospital Discharge Checklist Hospital Coverage Quick Screen Hospital Discharge Rights & Action Steps Glossary of Terms Federal Regulations Introduction The Center for Medicare Advocacy produced this packet to help you understand Medicare coverage and how to file an appeal if appropriate.  Medicare is the national health insurance program to which many people with disabilities … Read more →

Introduction Checklist for Skilled Nursing Facility (SNF) Appeals Quick Screen: Should My SNF Care Be Covered By Medicare? Skilled Nursing Facility Appeal Details Additional Information The “Improvement Standard” Myth and Skilled Nursing Facility Care Glossary of Terms Federal Regulations – SNF Coverage Federal Regulations – Expedited Appeals Centers for Medicare & Medicaid Services (CMS) Manual Provisions 1. Introduction … Read more →