Medicare Beneficiaries Can Have Denied Claims Re-Reviewed

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.