Home Health & Hospice Week

Court decision may impact how Medicare pays for patients who aren’t improving.

You could have fewer hassles getting Medicare payments for therapy services to patients whose conditions are "unlikely to improve," thanks to an imminent legal settlement.

Consumer advocates won their case against the federal government, providing fee-for-service Medicare and private Medicare Advantage beneficiaries with better coverage for skilled nursing services, as well as physical, speech and occupational therapy, reports the Wall Street Journal. The settlement -- expected to become finalized on Jan. 24, 2013 -- will end Medicare’s practice of denying coverage for such services to patients whose conditions are "unlikely to improve."

The settlement will undoubtedly impact Medicare beneficiaries with chronic conditions. But despite the settlement, your patients will likely still face claims denials until the Centers for Medicare & Medicaid Services updates the "improving" stipulation in its manuals. But under the settlement, your patients who had a denied claim after Jan. 18, 2011 based on their having a condition that’s unlikely to improve are entitled to a "special" appeal, the Wall Street Journal states.