Jimmo

When preparing for the future, don't forget about LTC costs

When preparing for the future, don't forget about LTC costs

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.

The G-codes are here for payment claims — ready or not

The G-codes are here for payment claims — ready or not By

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.

CMS fact sheet gives rules on 'maintenance' caregiving

CMS fact sheet gives rules on 'maintenance' caregiving By

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 document

Medicare coverage of 'maintenance therapy' determined by need for skilled care, CMS clarifies in Jimmo document By

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.

A study that may never be done — but should

A study that may never be done — but should By

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.

Regulations for nursing home ethics programs and QAPI still in the works, administrators say

Regulations for nursing home ethics programs and QAPI still in the works, administrators say By

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.

Settlement will expand therapy

Settlement will expand therapy By

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 mythical standard

The mythical standard By

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.

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