Therapy utilization will be as scrutinized as much as it ever has been, even though the "improvement standard" has once again been deemed deceased.
While pleased with a court decision mandating that the Centers for Medicare & Medicaid Services should do better in explaining maintenance coverage under the landmark Jimmo case, leading long-term care experts said more can be done.
In some ways, 2014 has been a monumental year. But it's not over yet, especially with regard to Centers for Medicare & Medicaid Services steps regarding the historic Jimmo settlement agreement signed on Jan. 24, 2013.
Glenda Jimmo has reached a settlement with the federal government and will finally receive Medicare coverage for claims that were denied in 2007, which led her to file a class-action lawsuit over the so-called "improvement standard."
Medicare officials continue to cite an "improvement standard" as a reason for withholding benefits from Glenda Jimmo, whose 2012 legal victory was supposed to end this type of denial, Kaiser Health News reported Monday. The situation shows why both beneficiaries and providers are confused about current policy, and why some nursing homes continue to expect business-as-usual, an expert told McKnight's.
Hospitals object to collecting their own data as part of post-acute reform, urge revisions to draft legislationMay 15, 2014
Hospitals should not be required to collect patient assessment data as part of an effort to revamp post-acute care, the leader of the American Hospital Association argued in a recent letter to top Congressional lawmakers.
Skilled nursing providers remain confused about Medicare changes related to the Jimmo v. Sebelius legal settlement, and many beneficiaries are not aware that their therapy might now be eligible for coverage, according to prominent long-term care expert Judith Stein. Stein is an attorney and director of the Center for Medicare Advocacy, which along with Vermont Legal Aid filed the Jimmo case.
When a patient is referred to therapy, and they are receiving hospice care, then therapy needs to seek permission from the hospice company to provide any treatment. Hospice is required to reimburse the facility for the therapy services since the treatment also is included in the bundled payment rate from Medicare Part A. And, therein lies the rub.
How many clinicians (physical, occupational, and speech therapy) can honestly say that they have achieved full independence with 100% of every patient they have ever worked with? Unfortunately, I definitely cannot make that claim myself. But is that always the intention anyway?
Skilled nursing facilities should not claim that therapy was to maintain a patient's condition if documentation reflected only an improvement goal.
Skilled nursing facilities may be reimbursed for maintenance therapy services performed by assistants, the Centers for Medicare & Medicaid Services clarified in a recent Medicare Benefit Policy manual revision. CMS officials announced and explained the revision in an Open Door Forum call Thursday.
How come there are so many Medicare A denials when Jimmo v. Sebelius stated we could keep residents on Medicare A even if they are not improving?
For the second week in a row, the Centers for Medicare & Medicaid Services has postponed an eagerly awaited SNF Open Door Forum conference call that will focus on accommodations from the Jimmo case and other hot topics. It will now take place at 2 p.m. Eastern on Thursday, Dec. 19, according to various reports. Regulators have said when the call takes place, they also will be making a "Medicare" announcement, and will address MDS training and the National Partnership to Improve Dementia Care in Nursing Homes during the call.
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.
The Centers for Medicare & Medicaid Services will now hold an eagerly awaited SNF Open Door Forum conference call that will focus on accommodations from the Jimmo case and other hot topics next Thursday. Officials abruptly announced a one-week postponement yesterday. Regulators said they will be making a "Medicare" announcement, and also will address MDS training, and the National Partnership to Improve Dementia Care in Nursing Homes during the call.
On Jan. 24 of this year, the Jimmo vs. Sebelius class action lawsuit was settled. This was a significant win for us, the healthcare providers. As we continue to work out the details, I feel now is a good time for a reminder of the ins and outs the lawsuit. No doubt about it, it was a blockbuster decision.
In recent years, many skilled care operators have nervously watched the Centers for Medicare & Medicaid Services reduce and sometimes eliminate payments for physical, occupational and speech therapy services. But thanks to a recent class-action lawsuit settlement, the funding pendulum might be about to change direction. As a result, the skilled care sector could be in for a massive funding windfall.
Many recent articles are warning about the future healthcare costs that retirees face, despite having Medicare for their primary health insurance. Medicare does leave 20% of many medical related costs to the Medicare recipient, in addition to a hefty copayment for hospital admission and more. Fortunately, Medicare supplements or Medicare Advantage insurance policies cover the majority of these out of pocket expenses.
Effective July 1, the Centers for Medicare & Medicaid Services will begin rejecting claims received for Medicare Part B patients that do not include the new requirement of G-coding. That really means providers need to be ready by June 1.
The Centers for Medicare & Medicaid Services has issued a fact sheet, that clarifies the conditions the terms under which "maintenance therapy" will be covered by Medicare.
Medicare coverage of 'maintenance therapy' determined by need for skilled care, CMS clarifies in Jimmo documentApril 16, 2013
Providers must sufficiently document the need for skilled care in order to obtain Medicare coverage for so-called "maintenance therapy," the Centers for Medicare & Medicaid Services stressed in a recent fact sheet on the Jimmo v. Sebelius settlement agreement.
Government agencies and lobbyists are famous for conducting studies that prove a point — theirs, namely. That's why I'll be very interested to see who will have the courage to conduct one of the most important long-term care-related studies that should be completed over the coming year.
The Centers for Medicare & Medicaid Services is still working on the regulations for ethics and compliance programs that nursing homes were supposed to have implemented this month, CMS administrators admitted in an Open Door Forum call Thursday.
It's official: A federal judge approved a settlement agreement the last week of January that will allow Medicare patients to continue receiving therapy services even if they are not making measurable improvement.
The Jimmo vs. Sebelius case, filed in January 2011 in federal district court in Vermont, has now been settled. The class action lawsuit challenged Medicare's use of an "improvement standard" in determining medical necessity for skilled nursing services and outpatient therapy.