Jimmo V. Sebelius
Accurate and thorough nursing documentation is the crucial factor in determining medical necessity. As nursing leaders in long-term care, we are obligated to ensure that Medicare documentation standards meet the premise of reasonable and necessary care and services.
Why would anyone mention value-based reimbursement, medical necessity and the Jimmo lawsuit in the same sentence? I feel they are all related, but it will be difficult to find the perfect balancing act to maximize the benefits of each topic.
In seeking Medicare reimbursement, skilled nursing facilities should not claim that therapy was to maintain a patient's condition if documentation reflected only an improvement goal, according to officials with the Centers for Medicare & Medicaid Services.
The Centers for Medicare & Medicaid Services has revised the Medicare Benefit Policy manual to clarify that skilled care and skilled therapy may be covered even for conditions that will not improve, per the settlement in the high-profile Jimmo v. Sebelius case.
Marking another step toward guaranteeing Medicare coverage for nursing home residents needing skilled services, a federal judge on Thursday approved the October 2012 settlement agreement in Jimmo v. Sebelius.
Federal health officials have agreed to changes in Medicare coverage rules that would make it easier for beneficiaries with chronic conditions to qualify for nursing home stays, outpatient therapy and home healthcare services, according to reports.