Medicare

Medicare health and drug plans make changes each year—things like cost, coverage, and what providers and pharmacies are in their networks. October 15 – December 7 marks the annual Open Enrollment Period when individuals with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs. Per […]

The Centers for Medicare & Medicaid Services reminds the Medicare community of the Jimmo Settlement Agreement (January 2013), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or […]

Decision in Alexander v. Price Means Medicare Patients Could Gain Right to Appeal Placement on “Observation Status” and Avoid Large Medical Bills On July 31, 2017, a Connecticut federal district court issued decision  certifying a nationwide class of hospital patients who may gain the right to appeal their placement on observation status.  In Alexander v. Price, 3:11-CV-1703 (MPS), Judge […]

Although the Republican health care plan was defeated, we still have work to do to have an optimal health care system for all Americans.  The Affordable Care Act known as Obamacare still needs improvement.  The existing American health care system is extremely complex. More than 57 million seniors and disabled adults depend on Medicare, but too many people […]

On February 16, 2017, the Jimmo v. Sebelius court approved a Corrective Statement to be used by the Centers for Medicare and Medicaid Services (CMS) to affirmatively disavow the use of an “Improvement Standard” for Medicare coverage.  The government will use the statement as part of its Corrective Action Plan, which was ordered by the court last […]

Observation Status is a designation used by hospitals to bill Medicare. Unfortunately, it can hurt hospital patients who rely on Medicare for their health care coverage.  People who receive care in hospitals, even overnight and for several days, may learn they have not actually been admitted as inpatients. Instead, the hospital has classified them as […]

A settlement agreement in Jimmo v. Sebelius required the Secretary of Health and Human Services to follow a “maintenance coverage standard” under which skilled nursing services would be covered by Medicare if they were necessary to maintain the patient’s current condition or prevent deterioration, rather under a so called “improvement standard.” The federal district court […]

Premiums for Medicare Part B will rise by a modest amount in the new year. The average premium for Part B, which covers physician services, outpatient hospital services and medical equipment, will rise to approximately $109 for most retirees, according to an announcement from the Centers for Medicare & Medicaid Services. That’s just slightly more […]

After the election results, it is to be determined what changes may occur to the Affordable Care  Act, commonly referred to as Obamacare.  However, a new benefit for Medicare beneficiaries is scheduled to begin in 2018.  Medicare will start paying for a strategy to help millions of older Americans at high risk of diabetes from developing the disease. […]

The Medicare Open Enrollment Period for 2017 has arrived.  For a quick rundown on what you need to know, take a look at this basic Q&A. What is it? Throughout the year, Medicare has different enrollment periods. The Open Enrollment Period, or OEP, is the timeframe during which Medicare beneficiaries (people with Medicare) can make […]

In an Opinion and Order released on August 18, 2016, Chief Judge Christina Reiss, who oversees the “Improvement Standard” case (Jimmo v. Burwell, No. 11-cv-17 (D.Vt.)), ordered the federal government, through its Centers for Medicare & Medicaid Services (CMS), to comply with the Settlement Agreement that she had approved in January 2013.  The Order requires CMS […]

The issue of observation status involves a patient in a hospital who receives medically necessary care, tests, treatment, and medications ordered by their physicians but are in observation status or are otherwise called an outpatient, rather than an admitted inpatient.  The primary consequence for patients of the inpatient/outpatient Medicare billing distinction is financial: Medicare will not […]

The federal government released its first overall hospital quality rating last week, giving average or below average scores on many of the nation’s best-known hospitals while awarding top scores to dozens of unheralded ones. The Centers for Medicare & Medicaid Services rated 3,617 hospitals on a one- to five-star scale, angering the hospital industry, which has been […]