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    Medicare Handbook, 2012 Edition

    ISBN-10: 0735509182
    ISBN-13: 9780735509184
    Author(s): Judith A. Stein, Jr. Chiplin
    Description: To provide effective service in helping clients understand how they aregoing to be affected by health care reform and how to obtain coverage,pursue an appeal, or plan for long-term care or retirement, you need thelatest Medicare guidelines from a  More...
    Buy it from: $85.70
    This item will ship on Wednesday, November 26 .

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    List Price: $265.00
    Publisher: Wolters Kluwer Law & Business
    Binding: Paperback
    Pages: 976
    Size: 7.50" wide x 10.25" long x 2.00" tall
    Weight: 3.652
    Language: English

    To provide effective service in helping clients understand how they aregoing to be affected by health care reform and how to obtain coverage,pursue an appeal, or plan for long-term care or retirement, you need thelatest Medicare guidelines from a source you can trust - the 2012Edition of Medicare Handbook.Prepared by experts from the Center for Medicare Advocacy, Inc., Medicare Handbook covers the issues you need to provideeffective planning advice or advocacy services, including:Medicare eligibility and enrollmentMedicare-covered services, deductibles, and co-paymentsCo-insurance, premiums, and penaltiesFederal coordinated care issuesGrievance and appeals proceduresFace-to-face encounter requirements for home health and hospice careMedicare Handbook also provides you with coverage rulesfor:Obtaining Medicare-covered servicesPrescription drug benefit and the Low-Income Subsidy (LIS)The Medicare Advantage ProgramDurable Medical Equipment (DME)Preventive servicesAppealing coverage denialsand an understanding of: The Medicare Secondary Payer Program (MSP)The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies(DMEPOS) Competitive Acquisition ProgramIncome-related premiums for Parts B and DThe 2012 Medicare Handbook provides important informationabout the relationship of private insurance to the Medicare program.Other changes discussed include:Hospital noticesCurrent physical, speech, and occupational therapy payment capsPayments to, and reliance upon, managed care plans (Medicare Advantage)Protections for individual

    An Introduction to Medicare Coverage and Appeals
    History and Overview
    Enrollment and Eligibility
    Medicare Savings Programs
    The Medicare Appeals Process
    Hospital Coverage
    Eligibility for Medicare Hospital Insurance (Part A)
    Application or Enrollment for Medicare Part A
    Scope of Benefits - Inpatient Hospital Coverage Benefit Periods
    Medicare-Covered Services
    Coverage Criteria Explained
    Limitations on Payment for Services
    The Medical Necessity Standard for Inpatient Hospital Stays
    Hospital Payment
    Utilization Review and Quality of Services
    Appealing Coverage Denials
    Denial and Appeal Process
    How to Develop a Winning Appeal
    Skilled Nursing Facility Coverage
    Qualifying Criteria
    Identifying Coverable Cases
    SNF Prospective Payment System and Resource Utilization Groups
    Problem Areas of Concern for the Advocate
    Pre-Appeals Advocacy
    Home Health Coverage
    Requirements for Coverage
    Chronic, Stable, and Maintenance-Level Patients
    Prospective Payment System (PPS) for Home Health Services
    Claims Submission, Determination, and Appeal
    The Role of Advocacy
    How to Develop a Winning Appeal
    Hospice Coverage
    Election of the Hospice Benefit
    Who May Make an Election for Hospice Care
    Hospice Admission
    Patient Rights
    Hospice Revocation
    Hospice Discharge
    Changing Hospice Providers
    Hospice Services
    Medicare Rules for Hospice Inpatient Care
    Medicare Hospice Inpatient Cap
    Hospice Care for Residents of Facilities
    Deductibles and Coinsurance for Non-Hospice Care
    The Appeals Process
    The Medicare Prescription Drug, Improvement, and Modernization Act of 2003
    Medicare Part B: Supplementary Medical Insurance Benefits for the Aged and Disabled
    Enrollment and Payment Requirements
    Covered Medical and Other Health Care Services
    Medicare Assignment Program
    Filing Medicare Part B Claims
    Information About Coverage Appeals
    Appointments of Representatives and Attorneys' Fees
    Medicare Advantage: Coordinated Care Plans, Private Fee-for-Service, and Other Delivery of Services Options
    Advantages and Disadvantages of Medicare Advantage Options
    Guidelines for Considering Medicare Advantage Options
    Medicare Advantage
    Medicare Advantage Quality Improvement Program
    Medigap Services
    Medicare Certification of Policies
    Standardized Plans
    High Deductible Plans
    Medicare SELECT
    Legislated Policy Changes
    Consumer Protections
    Prohibition Against Sale of Duplicate Policies
    Required Ratio of Aggregate Benefits to Aggregate Premiums
    Coverage of Preexisting Conditions
    Dissemination of Information About Medigap Policy Benefits
    Adding Cost-Sharing to Medigap Policies
    Medicare's Relationship with Private Insurance
    Employer Group Health Plans
    Calculation of Medicare Secondary Payment Amount in EGHP Cases
    Enforcement of EGHP Claims
    Coordination of COBRA Rights and Medicare
    MSP Rules Applicable to Medicare Advantage Plans

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