Ever since Cindy Hasz opened her geriatric care management business in San Diego 13 years ago, she has been fighting a losing battle for clients unable to get Medicare coverage for physical therapy because they “plateaued” and were not getting better.
“It has been standard operating procedure that patients will be discontinued from therapy services because they are not improving,” she said.
No more. In January, Medicare officials updated the agency’s policy manual — the rule book for everything Medicare does — to erase any notion that improvement is necessary to receive coverage for skilled care. That means Medicare now will pay for physical therapy, nursing care and other services for beneficiaries with chronic diseases like multiple sclerosis, Parkinson’s or Alzheimer’s disease in order to maintain their condition and prevent deterioration.
But don’t look for an announcement about the changes in the mail, or even a prominent notice on the Medicare website. Medicare officials were required to inform health care providers, bill processors, auditors, Medicare Advantage plans, the 800-MEDICARE information line and appeals judges — but not beneficiaries.
Thanks to Tony Munter.
It is still not that easy to get a continuance once the home care agency decides to terminate. You have to appeal to some contract company, and they can still decide that therapy is not “medically necessary” even though it is keeping your mom up and walking. There is another level of appeal, but it will take months. I know. I went through this process with my mother. The agency is still afraid of being accused of abusing the system and getting audited.
Those who want to appeal can try this: http://www.medicareadvocacy.org/
THANK YOU FOR POSTING THIS MUCH-NEEDED INFORMATION!