Wednesday, October 21, 2015

More Education on Medicare Maintenance Coverage Sought

Dan Ciolek
An October 20 Bloomberg BNA article cites concerns from the Center For Medicare Advocacy (CMA) that the Centers for Medicare and Medicaid Services (CMS) is not doing enough to educate providers that the agency covers maintenance nursing and therapy services. Per provisions of the Jimmo v. Sebelius settlement agreement in 2013, CMS was to update policy and educational materials to confirm that there is no “improvement standard” required for Medicare coverage, and coverage can be available to maintain or prevent decline of a patient’s condition.

Daniel Ciolek, the senior director of therapy advocacy at AHCA told Bloomberg BNA that the group “has been quite concerned about the paucity of educational materials provided to providers and patients related to the appropriate provision of skilled nursing and therapy services, and we have seen nothing new since the mandated provider manual updates were released in January 2014.”

Alice Bers, an attorney with CMA told Bloomberg BNA that she is hearing that “some providers still aren't aware” Medicare will cover maintenance services. “In addition, providers may be reluctant to provide maintenance services for fear that Medicare will deny the claim”, Bers said.

CMS officials indicated to Bloomberg BNA that the agency “has successfully carried out an extensive educational campaign including meeting all educational requirements” of the Jimmo settlement agreement.”

“The CMA would like to see the CMS move away from a “static” outreach model and develop a more sustained approach to educating providers and beneficiaries about the Jimmo settlement”, Bers told Bloomberg BNA. 

Ciolek agreed with Bers that the CMS should schedule calls and webinars about the settlement. Specifically, more outreach along the lines of updated frequently asked question documents, updated Medicare Learning Network articles, Open Door Forum calls, “and other educational media within the CMS Medicare Learning Network would be welcomed by the AHCA skilled nursing provider community,” Ciolek said.

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