Advanced Search

Home Health & Hospice Week

Industry Note:

Court Highlights Hospice Beneficiary Appeal Process

Published on Wed Aug 08, 2012

Hospices may have to cover more drugs and services they don't approve, thanks to a court case clarifying how hospice beneficiaries can appeal hospices' coverage decisions.In an opinion released last month, the U.S. Court of Appeals for the Ninth Circuit informed the plaintiff that Medicare has an official appeals process for hospice beneficiaries who want to dispute drugs or services a hospice doesn't cover.Background: In 2007, Howard Back's wife was prescribed Actiq for uncontrolled pain, but the hospice didn't cover it, according to the opinion in Back v. Sebelius. Back paid nearly $6,000 for the drug out of pocket until his wife died in March 2008. When Back submitted the bill to the hospice, it declined to pay. Then Back received a series of incorrect information from the hospice, the contractor, and the Centers for Medicare & Medicaid Services about how to appeal. Back ultimately filed suit and was told [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Home Health & Hospice Week

View All