Medicare Handbook: 2013 Edition

ISBN-10: 1454810459
ISBN-13: 9781454810452
Edition: 2012
List price: $289.00
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Description: To provide effective service in helping clients understand how they are goingto be affected by health care reform and how to obtain coverage, pursue anappeal, or plan for long-term care or retirement, you need the latest Medicareguidelines from a  More...

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Book details

List price: $289.00
Copyright year: 2012
Publisher: Aspen Pub
Binding: Paperback
Pages: 1000
Size: 7.25" wide x 10.00" long x 2.00" tall
Weight: 3.740
Language: English

To provide effective service in helping clients understand how they are goingto be affected by health care reform and how to obtain coverage, pursue anappeal, or plan for long-term care or retirement, you need the latest Medicareguidelines from a source you can trust - the 2013 Edition ofMedicare Handbook .Prepared by experts from the Center for Medicare Advocacy, Inc.,Medicare Handbook covers the issues you need to provide effectiveplanning 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 rules for: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 2013 Edition has been updated to include information andstrategies necessary to incorporate ACA provisions on behalf of people in needof health care.In addition, the 2013 Medicare Handbook will also help advocatescontest limited coverage under private Medicare Part C plans (MedicareAdvantage) and understand initiatives to reduce overpayments to MedicareAdvantage.Other Medicare developments discussed in the 2013 Medicare Handbookinclude:Implementation of important provisions of the Affordable Care ActBeneficiary rights, when moving from one care setting to anotherDevelopments in the Medicare Home Health and Hospice BenefitsAdditional information regarding preventive benefitsContinued changes in Medicare coverage for durable medical equipment

An Introduction to Medicare Coverage and Appeals
History and Overview
Financing Administration
Enrollment and Eligibility
Coverage 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
Coverage Qualifying Criteria
Identifying Coverable Cases
SNF Prospective Payment System and Resource Utilization Groups
Problem Areas of Concern for the Advocate
Pre-Appeals Advocacy Appeals
Home Health Coverage
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
Eligibility 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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