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