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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 [...]
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