Residents can appeal Medicare terminations through new process

Share this content:

Medicare fee-for-service beneficiaries in skilled nursing facilities will be able to appeal terminations of their Medicare coverage through a new, expedited review process beginning in July.

The Centers for Medicare & Medicaid Services announced the accelerated review process this week. Besides SNFs, the review process covers disputed terminations of services in hospices, home health agencies and comprehensive outpatient rehabilitation facilities.

According to the new process, providers must give notice of Medicare termination to beneficiaries at least two days before coverage ends. If beneficiaries disagree with the termination, they can request an expedited review of the decision by the Quality Improvement Organization in their state. The provider then provides the beneficiary and QIO with a detailed explanation of why the services no longer will be covered.

See the following Web site for more information: http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0538.pdf.