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Medicare Discharge Planning: Think Through Your Needs

Discharge planning is an important tool for reviewing and making arrangements for on-going healthcare needs across healthcare settings, including hospitals, skilled nursing facilities, home health, or hospice

Hospice News: the Good, the Bad, the Ugly

The Center for Medicare Advocacy applauds Connecticut and any other states that initiate a Medicaid hospice benefit. That said, however, caution must be taken in oversight of providers, and in correcting misrepresentations about hospice care that might undermine the program.

Limits on Medicare’s Recovery Health Care Payments When the Beneficiary Has Liability or Workers’ Compensation Insurance

MSP requirements apply to Medicare beneficiaries with Workers' Compensation and to those with liability insurance, but the application of the law by the Centers for Medicare and Medicaid Services (CMS) differs significantly in these two situations.

Part Covered, Part Not: "Straddle Claims" in Medicare Part D

Medicare Part D coverage is complex, particularly when a prescription drug claim crosses multiple phases of the benefit. These "straddle claims" make it particularly challenging to determine what a beneficiary owes, but it is important to be accurate, particularly when the claim straddles a coverage gap, resulting in expense to the beneficiary.

Medicare Cost-Sharing for Dual Eligibles: Who Pays What for Whom?

Guidance released recently by the Centers for Medicare & Medicaid Services (CMS) sheds new light on an issue that has created hardships for beneficiaries and challenges for advocates trying to help them.

Medicare Coverage of Power Mobility Devices: Tips and Reminders

Beneficiaries who want Medicare coverage for a Powered Mobility Device (PMD) will be successful provided they can show mobility limitations that impair their ability to engage in Mobility Related Activities of Daily Living (MRADLs), that their use of the PMD will improve their ability to do MRADLs and that the PMD can be used safely within the home.

Important Health Care Lacking for Older People

Older Americans are not getting six key preventive services or appropriate treatment for hypertension that clinical practice guidelines indicate they generally should receive, according to two studies recently published in the Journal of the American Medical Association.

Myths About Nursing Home Tort Reforms

The Center for Medicare Advocacy performed a study entitled Tort Reform and Nursing Homes that deflates the myths that pervade the nursing home industry’s discussion of tort litigation. It found that cases about nursing home abuses are not frivolous.

Important Provisions Reinstated In Medicare Skilled Nursing Facility Regulations

In July,1998 revisions were made to the federal regulations which made significant changes to the Medicare skilled nursing facility level-of-care requirements.

The Medicare Prospective Payment System (SNF)

Until July, 1998, nursing homes used to be reimbursed for care provided to Medicare Part A-covered residents residing in Medicare-certified beds through a retrospective cost-based system. The Balanced Budget Act mandated a prospective per diem rate for the Medicare SNF benefit.

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