Federal Court Orders Appeal Rights on “Observation Status” Issue for Certain Medicare Hospital Patients

Medicare beneficiaries who have been denied coverage for nursing home stays because their time in the hospital was changed from “inpatient” to “observation care” can now appeal to Medicare for reimbursement, a federal judge in Hartford, Conn., ruled last week. The decision opens the door to medically necessary services in skilled nursing facilities that Medicare beneficiaries might otherwise have to forgo because they cannot afford to pay for it themselves. The distinction between being labeled a hospital “inpatient” versus being placed on observation status is important because Medicare only [...]

By |2020-03-30T14:25:00-04:00March 30th, 2020|Blog, Medicare|

The New Medicare Patient Driven Payment Model (PDPM): What Does It Mean for Nursing Home Residents?

As an advocate for nursing home residents, Rothkoff Law Group strives to educate our clients, their families and consumers about regulatory changes that may affect the care their loved ones receive.   In October 2019, the Centers for Medicare and Medicaid Services (CMS) implemented a new payment model for skilled nursing facilities (SNFs), the Patient-Driven Payment Model (PDPM).  PDPM is described by CMS as a patient-driven care model  that focuses on the diagnoses and characteristics of the patient rather than the services, including the therapy services, provided to them. The [...]

By |2020-02-07T09:23:01-05:00February 3rd, 2020|Blog, Medicare, Nursing Home|

The Need for Medicare Dental Coverage

Medicare has done so many wonderful things for older Americans since its inception in 1965.  However, to date, traditional Medicare does not cover dental care. Traditional Medicare does not cover preventive dental services like exams, cleanings, and x-rays.  Nor does it cover basic or major restorative services and items like fillings, extractions, root canals and dentures.  When such dental work must be performed in a hospital setting due to the severity of the procedure or the patient’s underlying medical condition or clinical status, Medicare will cover the costs of [...]

By |2020-02-07T09:48:11-05:00December 9th, 2019|Blog, Elder Care, Medicare|

Are Nursing Home Residents Receiving Less Therapy?

Medicare’s new reimbursement system for skilled nursing facilities (SNFs), called Patient-Driven Payment Model (PDPM),changed reimbursement rules and the financial incentives for SNFs, effective October 1, 2019.  As a result, nursing home skilled nursing residents who are receiving rehabilitation care may be receiving less therapy than prior to October 1, 2019. Prior to Oct. 1, 2019, Medicare reimbursed nursing homes for therapy based on the number of minutes provided to each patient, up to 720 minutes a week. The goal is to help patients regain mobility and the ability to [...]

By |2020-02-07T09:49:12-05:00December 2nd, 2019|Blog, Medicare|

Assistance with Medicare Skilled Nursing Appeals

Medicare coverage of nursing home care depends on a resident’s need for skilled nursing and/or therapy, not the resident’s potential for improvement. However, too many nursing home residents continue to be denied skilled services on the basis of an “Improvement Standard,” which was firmly rejected by the court-approved settlement in Jimmo v. Sebelius.  In order to help nursing home residents and their families challenge these unfair denials, the California Advocates for Nursing Home Reform (CANHR) have prepared an in-depth discussion on filing expedited or fast-track Medicare appeals and offers guidance on [...]

By |2020-02-07T09:52:16-05:00November 11th, 2019|Blog, Medicare|

Changes To Medicare Nursing Home Covered Care

Pursuant to the Center for Medicare Advocacy, on October 1, 2019, the Centers for Medicare & Medicaid Services (CMS) implemented a new payment system for Medicare-covered nursing home stays—the “Patient Driven Payment Model” (PDPM). PDPM creates new financial incentives for nursing homes and new challenges for nursing home residents. One of the biggest challenges for residents under PDPM is access to skilled therapy. The Center for Medicare Advocacy and the Long Term Care Community Coalition have developed a new Issue Alert to help residents and their families understand the implications of PDPM [...]

By |2020-02-07T09:55:02-05:00October 21st, 2019|Blog, Medicare|

Update on the Jimmo Case – Medicare Coverage for Skilled Nursing Care

The 2013 Settlement in Jimmo v. Sebelius confirmed that Medicare coverage should be determined based on a beneficiary’s need for skilled care (nursing or therapy), not on the individual’s potential for improvement. Unfortunately, more than six years after the Settlement’s approval, Medicare beneficiaries and providers across the country are still having significant problems with the implementation of the Settlement. The Center for Medicare Advocacy with support form the John A. Hartford Foundation, has compiled an Issue Brief to provide Medicare stakeholders with an overview of the Jimmo Settlement, what [...]

By |2020-02-07T10:57:29-05:00July 1st, 2019|Blog, Medicare|

Reflections on the 6th Annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture

On May 9, 2019, members of the Rothkoff Law team including Jerry Rothkoff, Bryan Adler, Roxanne Crowley, Kaitlin Dirxx, and Chelsea Ganssle traveled to Washington, DC to attend the Center for Medicare Advocacy’s sixth annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture at the Kaiser Family Foundation.  The theme of the day was Health Care as a Human Right: Medicare’s Role in Making it a Reality. The Summit convened advocates, leading experts, and policy-makers to discuss access to quality health care for all, the challenges and [...]

By |2020-02-07T11:28:53-05:00May 20th, 2019|Blog, Medicaid, Medicare|

The Start of the Presidential Debate Regarding Long-term Care Coverage

During the 2016 Presidential campaign, a major issue effecting virtually all American families was noticeably absent from the debate – long-term care coverage.  Hopefully, that is about to change heading into the 2020 Presidential campaign.  Senator Bernie Sanders and his Democratic colleagues in the House  have included a long-term care benefit as part of the “Medicare for All” bill.  I am not stating that Senator Sanders or the Democrats solution to long-term care coverage in this country is the correct solution.  In fact, the Democrats have not proposed how [...]

By |2020-02-07T11:43:11-05:00March 11th, 2019|Blog, Medicare|

2019 Elder Law Numbers

The Centers for Medicare and Medicaid Services (CMS) has released the new Medicare premiums, deductibles, and co-payments for 2019:• Basic Part B premium: $135.50/month (was $134.00 in 2018)• Part B deductible: $185 ($183.00 in 2018)• Part A deductible: $1,364 (was $1,340 in 2018)• Co-payment for hospital stay days 61-90: $341/day (was $335 in 2018); Co-paymentfor hospital stay days 91-150: $682/day (was $670 in 2018)• All costs for each day beyond 150 days• Skilled nursing facility co-payment, days 21-100: $170.50/day (was $167.50 in 2018)Also, note that individuals with annual incomes [...]

By |2020-02-07T11:52:51-05:00December 31st, 2018|Blog, Medicaid, Medicare|

Doctors Give Medicare’s Proposal To Pay For Telemedicine Poor Prognosis

Telemedicine offers many opportunities to better monitor care in the future.  A new proposal by the Trump administration would authorize Medicare for the first time to embrace telemedicine across the country by paying doctors $14 for a five-minute “check-in” phone call with their patients.  However, the proposal has many critics.  Many physicians say the proposed reimbursement will cover a service they already do for free. And the Medicare reimbursement — intended to motivate doctors to communicate with patients outside the office — could have a chilling effect on patients [...]

By |2020-02-21T11:44:18-05:00October 29th, 2018|Blog, Medicare|

Medicare to Implement Financial Penalties For Nursing Homes with High Hospital Readmission Rates Effective October 1, 2018

Modeled after a program that encourages low readmission rates to hospitals, the Centers for Medicare and Medicaid Services (CMS) will introduce a new financial incentive program effective October 1, 2018 for skilled nursing facilities. CMS will withhold 2% of a facility’s Medicare reimbursement until they have shown that they can keep down the number of their residents who return to a hospital within 30 days of discharge. What does this mean for nursing home residents?  In theory, the new regulations will improve nursing home discharge planning by making nursing [...]

By |2020-02-21T11:30:40-05:00October 1st, 2018|Blog, Medicaid, Medicare|

SSA Issues Warning of Social Security and Medicare Fraud

For the fourth time this year the Social Security Administration (SSA) is warning seniors about fraudulent Social Security and Medicare communications targeting their benefits and their wallets.  Jim Borland, acting deputy commissioner for communications at the SSA said in a recent blog post titled Don’t Be Misled by False Medicare or Social Security Ads that “Online and otherwise, there’s a lot of information out there, and sometimes it’s difficult to tell what sources are credible. With millions of people relying on Social Security, scammers target audiences who are looking [...]

By |2020-02-21T11:56:45-05:00September 4th, 2018|Blog, Medicare, Social Security|

Medicare Beneficiaries To Be Issued New Medicare Cards

Medicare has started mailing new Medicare cards to all beneficiaries in New Jersey.  The new cards wills contain: New number called MEDICARE BENEFICIARY IDENTIFIER (MBI) 11 characters, mix of letters and numbers Random number  - not associated with SSA number, or how collecting benefits IMPORTANT REMINDERS: New cards are FREE. Beware of scams asking for money or bank information over the phone related to the new cards. Mailing will take time. Your card may arrive at a different time than your friend or neighbor. Make sure your mailing address [...]

By |2018-08-20T10:32:42-04:00August 20th, 2018|Blog, Medicare|
Load More Posts