Failure to Improve Is Still Being Used, Wrongly, to Deny Medicare Coverage

Patients whose conditions are deemed unlikely to improve are wrongfully being denied Medicare coverage for rehabilitation and therapy.

Medicare beneficiaries often hear such rationales for denying coverage of skilled nursing, home health care or outpatient therapy: They’re not improving. They’ve “reached a plateau.” They’re “stable and chronic,” or have achieved “maximum functional capacity.”

A federal judge last month ordered the federal Centers for Medicare and Medicaid Services to do a better job of informing health care providers and Medicare adjudicators that the so-called improvement standard was no longer in effect.

Read more about this important issue here.


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