Medicare Beneficiaries Can Have Denied Claims Re-Reviewed

February 1, 2014
Rick Gawenda

The Settlement Agreement in Jimmo v. Sebelius provides that Medicare beneficiaries who were previously denied Medicare coverage may have claims re-reviewed under the revised manual provisions.  The process is not automatic: people who wish to take advantage of the re-review process must fill out and submit a form, known as a Request for Re-Review.

Per the Medicare Advocacy Organization, a Medicare beneficiary is eligible for a review if he/she

1. Has received skilled nursing or therapy services in a skilled nursing facility, home health setting, or outpatient therapy setting, and
2. Has received a partial or full denial of Medicare coverage for those services based on the lack of improvement potential, and
3. The denial became final and non-appealable on or after January 18, 2011.

To access the Request for Re-Review form, click HERE.

All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.

This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.