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SchulerEB replied to the topic Medicare Skilled Therapy Denials due to lack of improvement should be appealed in the forum +ADL Forum: Directory Listed APHA Members Only 3 years, 2 months ago
This is a very important topic. Patients and many SNF staff do NOT know about the Jimmo settlement. I keep a copy of these two documents handy to educate them whenever I’m involved with a client in rehab or discussing discharge plans.…[Read more]
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Avrom Fox started the topic SSDI Appeals in the forum +ADL Forum: Directory Listed APHA Members Only 3 years, 2 months ago
I had a client who had applied for SSDI and was rejected. She asked me to help her with an appeal. I am familiar with the rules and regulations and agreed. I never expected that the appeal would evolve into a hearing before the administrative judge. I helped the client prepare for the hearing. She requested that I become her authorized…[Read more]
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marieconnolly replied to the topic Medicare Skilled Therapy Denials due to lack of improvement should be appealed in the forum +ADL Forum: Directory Listed APHA Members Only 3 years, 2 months ago
While I can’t quote Medicare guidelines, in my case management career. It has always been that the 21 days are pretty much a given for coverage. After that the patient must be making forward progress.
Hardly any one gets the full 100 days. (Although I seen a couple of folks who have tri-care secondary insurance. )
Also what I have…[Read more]
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kathy.quinn.advocacy replied to the topic Medicare Skilled Therapy Denials due to lack of improvement should be appealed in the forum +ADL Forum: Directory Listed APHA Members Only 3 years, 2 months ago
Thanks, Ailene for the very helpful links!
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Avrom Fox replied to the topic Pediatric Craniosynostosis in the forum General Conversation 3 years, 2 months ago
My daughter is 43 and YES she was born with this issue. She had many cranial facial surgeries. The key is to identify a team who does this frequently. Please call or email me.
I have 43 experience with this subject.Avrom Fox
Chicago Patient Advocacy
847 828 7497 -
asgadvocate replied to the topic Medicare Skilled Therapy Denials due to lack of improvement should be appealed in the forum +ADL Forum: Directory Listed APHA Members Only 3 years, 2 months ago
The Center for Medicare Advocacy has outstanding resources on this topic and CMS (Center for Medicare/Medicaid Services) has a dedicated page as well.
It is infuriating that clients are still facing this issue. I have worked with many clients regarding this issue since I began as an advocate in 2018 and have not only had to educate clients, but…[Read more]
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Avrom Fox started the topic Patient Advocates and SSDI in the forum General Conversation 3 years, 2 months ago
I had a client who had applied for SSDI and was rejected. She asked me to help her with an appeal. I am familiar with the rules and regulations and agreed. I never expected that the appeal would evolve into a hearing before the administrative judge. I helped the client prepare for the hearing. She requested that I become her authorized…[Read more]
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Houstonhealth replied to the topic Do you have expertise in Sickle Cell Disease? in the forum General Conversation 3 years, 2 months ago
I had a sickle cell client who had a terrible experience at a local hospital. It was a perfect storm of:
-Being 19 and not having a transition plan from pediatric care to adult care
-A hospitalist in the suburbs who had never seen a sickle cell patient (much less one in crisis)
Client was a patient at TX Childrens Hospital main campus in TX…[Read more]
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Deb Gordon started the topic Do you have expertise in Sickle Cell Disease? in the forum General Conversation 3 years, 2 months ago
Hi all,
I recently met with someone leading a public policy advocacy effort relating to Sickle Cell Disease and access to treatment. Do we have any members with expertise in Sickle Cell or in supporting patients with the disease? Just gathering information right now and I can share a little more with folks who may be interested. Please comment…[Read more]
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Janet Nelson replied to the topic So GOOD to meet you at ICOPA! in the forum General Conversation 3 years, 2 months ago
I didn’t know any of you before ICOPA, and now I know everyone who has posted here so far! And I recognize almost everyone who has liked the posts! I am so grateful to have met you all. It all seems much more real now, and I look forward to staying in touch and learning and growing with you all.
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kathy.quinn.advocacy started the topic Medicare Skilled Therapy Denials due to lack of improvement should be appealed in the forum +ADL Forum: Directory Listed APHA Members Only 3 years, 2 months ago
I am frustrated to see continued Medicare SNF coverage denials based on the requirement to show improvement for coverage. This is false and was clarified by CMS in 2013 in the Jimmo Settlement Agreement which states that Medicare covers skilled nursing care and skilled therapy services when a beneficiary needs skilled care to maintain function or…[Read more]
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Jennifer Kastner started the topic Coordination of Benefit Determination in the forum SIG – Medical Billing & Claims Forum 3 years, 2 months ago
Good afternoon All!
Many of my clients with multiple insurance policies and with medical billing issues often have issues related to coordination of benefits. So, I thought that I would share this resource released by CMS to help you determine which policy should be primary vs. secondary.
Locate it here:…[Read more]
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Althea P. Halchuck, EJD, CT, BCPA changed their profile picture 3 years, 2 months ago
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Alison Zavodny replied to the topic Question regarding PAC Board Certification Test in the forum SIG – Medical Billing & Claims Forum 3 years, 2 months ago
I’m a palliative care physician and passed the most recent exam. I also have a Masters in Bioethics and Health Policy. I read over the Ethics statement which is not unlike most others in the health care and counseling fields. Also looked at the study materials online but didn’t find them helpful probably because of my professional experience. It…[Read more]
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Julie Neff RN,BSN BCPA replied to the topic So GOOD to meet you at ICOPA! in the forum General Conversation 3 years, 2 months ago
All the amazing efforts and spirit put into this conference can’t be measured! Being able to connect with everyone and begin to form relationships was really fantastic! Thank you to all the folks who helped keep the flow going. The vendors were great and provided wonderful information. The Westin Staff was very friendly and helpful. You all really…[Read more]
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Carol Teplis MD changed their profile picture 3 years, 2 months ago
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Houstonhealth replied to the topic Pediatric Craniosynostosis in the forum General Conversation 3 years, 2 months ago
Any time! If you need one of us to walk you through appeals—just let us know! My relatives used to say that I would “argue with a fence post” (very Texas saying—not sure why anyone would argue with a fence post?)—and that’s true for many of us! I argue my own medical bills–just argued one for $38–just because! We are a group that loves…[Read more]
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gkriegs77gmail.com replied to the topic Question regarding PAC Board Certification Test in the forum SIG – Medical Billing & Claims Forum 3 years, 2 months ago
Jennifer,
My practice is like yours. I am not a standardized test taker. I am embarrassed to say, I have failed the test 3 times. Last time, my test would advance by itself. 2 questions I didn’t even answer because I didn’t know how to go back. Each test is different. I have a Master’s in Health Care Administration. I have worked on…[Read more]
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Lorelei Cheung's profile was updated 3 years, 2 months ago
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Lorelei Cheung replied to the topic Question regarding PAC Board Certification Test in the forum SIG – Medical Billing & Claims Forum 3 years, 2 months ago
I just took the past test and it was HARD and totally unexpected. I prepared for months, took prep classes and generally took studying very seriously and it still completely took me by surprise. It looks like PACB is in the process of updating the test again as they’ve made changes to their ethics policy. I’m thankful I passed as I am just lau…[Read more]
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