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MEDICARE “PROGRESS” STANDARD ELIMINATED

Medicare-Advice-for-2014Although the government agreed to settle a lawsuit (Jimnov v. Sebelius) in early 2013 whereby the government agreed that Medicare has been incorrect in requiring a patient to progress or improve to get skilled nursing services, home health and out-patient therapy covered by Medicare, the Center for Medicare and Medicaid Services (CMS) published revision on 12/6/13 so that Medicare cannot be terminated simply because the beneficiary has reached a “plateau”.  Service may be continued if skilled care is necessary and reasonable.  Medicare can pay up to 100 days of nursing facility coverage if the beneficiary is hospitalized for at least 3 days and nights.

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