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| An Introduction to Medicare Coverage and Appeals | |
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| History and Overview | |
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| Financing | |
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| Administration | |
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| Enrollment and Eligibility | |
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| Coverage | |
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| 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 | |
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| 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 | |
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| Appeals | |
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| Home Health Coverage | |
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| Coverage | |
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| 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 | |
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| 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 | |