Outpatient Maintenance Physical Therapy, Occupational Therapy and Speech Language Pathology Services (Medicare Benefit Policy Manual Ch. 5, §220.2D)Outpatient Physical Therapy, Occupational Therapy and Speech Language Pathology Services “may be … [Read more...] about Know Jimmo | The Medicare Policy Manual
The Improvement Standard
Know Jimmo | Right from the Medicare Agency
The Centers for Medicare & Medicaid Services (CMS) reminds the Medicare community of the Jimmo Settlement Agreement (January 2013), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under … [Read more...] about Know Jimmo | Right from the Medicare Agency
Know Jimmo | Share a Success Story
Have you or someone you know successfully argued for coverage of skilled care to maintain a condition, or slow decline, rather than being told there's a need to "improve?"Let us know! Share your story with us at … [Read more...] about Know Jimmo | Share a Success Story
Know Jimmo | It’s about the Care
Coverage does not turn on the presence or absence of potential for improvement but rather on the need for skilled care. Services can be skilled and covered when:CMS revised Medicare policy manuals, guidelines, instructions to reflect these … [Read more...] about Know Jimmo | It’s about the Care
Know Jimmo | No Improvement Needed
The Jimmo Settlement, approved by the federal district court in 2013, confirmed Medicare coverage should be determined by a beneficiary’s need for skilled care, not the individual’s potential for improvement; and that Medicare covers skilled care to … [Read more...] about Know Jimmo | No Improvement Needed
Know Jimmo | Jimmo Was a Historic Moment
As a new year of opportunities to make a difference with the Center for Medicare Advocacy’s community approaches, I’ve been reflecting on our important work, including a particular morning in the fall of 2012 when the Center’s Executive Director, … [Read more...] about Know Jimmo | Jimmo Was a Historic Moment
Know Jimmo | Priscilla’s Sister
The Jimmo Settlement Could Help Priscilla’s Sister Continue TherapyMy sister, who has an Alzheimer’s diagnosis, has been refused continuation of PT by the home care provider…They have discharged my sister from PT saying they will tell caregivers … [Read more...] about Know Jimmo | Priscilla’s Sister
Know Jimmo | When It’s Known, It Works
"My 92-year-old mother finally received payment this week related to her Second Level Appeal win against United Healthcare that was done by Livanta…my mother has now won 3 Medicare Appeals related to denial of skilled services received at a rehab/ … [Read more...] about Know Jimmo | When It’s Known, It Works
Know Jimmo – CMS Reminded Providers & Contractors in 2021
“Skilled Nursing Care & Skilled Therapy Services to Maintain Function Or Prevent or Slow Decline: ReminderMedicare covers skilled nursing care and skilled therapy services under skilled nursing facility, home health, and outpatient … [Read more...] about Know Jimmo – CMS Reminded Providers & Contractors in 2021
Know Jimmo | Medicare Law and CMS Policy Spell It Out
The Code of Federal Regulations:“Restoration potential is not the deciding factor in determining whether skilled care is required. Even if full recovery or medical improvement is not possible, a patient may need skilled services to prevent … [Read more...] about Know Jimmo | Medicare Law and CMS Policy Spell It Out