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."
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?
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.
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.