In yesterday's post I discussed how the standard has changed when determining if a patient remains eligible for Medicare coverage for their rehabilitation therapy. We are all familiar with the situation: a patient is discharged form the hospital to the rehabilitation facility. This care is covered by Medicare Part A. Yet, the coverage is only for 21-100 days! The Jimmo case settled the issue of standard for coverage; it is not an "improvement standard" that so many facilities continue to use! As we discussed yesterday:
"Per the Jimmo Settlement, Center for Medicare and Medicaid Services will now implement an Education Campaign to ensure that Medicare determinations for Skilled Nursing Facilities, Home Health, and Outpatient Therapy turn on the need for skilled care – not on the ability of an individual to improve. For most rehab patients, the Manual revisions and CMS Education Campaign clarify that coverage should never be denied because a patient cannot be expected to achieve complete independence in self-care or to return to his/her prior level of functioning."
Yet, what does one do if the facility still tried to use the "improvement standard, appeal!
The Center for Medicare Advocacy has developed a Self Help Packet for Expedited Skilled Nursing Facility Appeals, that includes appeals for "improvement standard" denials. It guides you step by step through the process.