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Medicare revises policies about therapy services coverage

from ACMA

Following the settlement to a class-action lawsuit filed against Kathleen Sebelius, Medicare notified health care providers that beneficiaries cannot be discontinued from therapy services if their condition does not improve. Now, patients with chronic disease such as multiple sclerosis, Parkinson's disease or Alzheimer's disease can continue to receive Medicare coverage for services such as physical therapy, nursing care and other services. However, coverage can still be denied for reasons other than lack of improvement. The beneficiary must still have a doctor's orders prescribing skilled nursing care, and the beneficiary also must have spent three consecutive midnights as an inpatient.

Additionally, beneficiaries whose Medicare coverage was denied solely for lack of patient improvement are able to have their claim re-reviewed. In order to receive reimbursement for care they paid for themselves, the final denial must be dated Jan. 18, 2011, through Jan. 24, 2013, and the beneficiary must submit the completed form by July 23. If this re-reviewed claim is denied again, the beneficiary may appeal through the regular appeals process. more


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