A loved one is brought from the hospital to a rehabilitation facility to receive nursing care and physical therapy treatment. Medicare is covering this cost. After a month of being provided with such care, the facility tells the family that their loved one is going to be denied Medicare coverage going forward because his condition is “no longer improving.” The family is faced with paying the private pay rate of a nursing home to the tune of $350.00 per day, or taking their loved one home when they are not ready because they cannot afford to pay this astronomical cost. Does this situation sound familiar to you?
There has been a recent trend amount nursing and rehabilitation facilities and agencies to deny Medicare services to patients because their conditions had not been “improving” during rehabilitative services. This “improvement standard” of assessing whether or not a patient should receive 100 days of Medicare has never been supported by Medicare regulations, and recently, the standard was successfully challenged in federal court.
What is being done to stop the practice of wrongfully denying Medicare coverage?
What if my Medicare coverage was denied years ago? Is coverage under Jimmo v. Sebelius retroactive?
Medicare denials under these circumstances can be reviewed from January 18, 2011 going forward. The Jimmo settlement also establishes a process of “re-review” for Medicare beneficiaries who received a denial of skilled nursing facility care, home health care, or out-patient therapy services. Read More
If you or loved one have been denied Medicare services because of a medical condition that has not “improved,” call Stefans Law Group, PC at 516-692-2744 and speak to one of our attorneys for legal assistance and professional guidance on your rights, and obtaining Medicare and Medicaid benefits you may be entitled to.