Re: The Settlement Agreement: See previous page by Sue
Here's another useful link from medicareadvocacy.org which tells how to work an appeal under jimmo v. sebelius. This is one of my major references as well as a fact sheet from medicare itself that I was/am planning to use. It's very clear that skilled care to prevent further deterioration can be covered. For me and my mom, the key statement (from the fact sheet) is "Conversely, coverage in this context would not be available in a situation where the beneficiary's care needs can be addressed safely and effectively through the use of nonskilled
Thus my question what is skilled. Not an easy question even for the therapists. As I said in the other post, our pt said it was a teaching function only. I tended to disagree.
I thought I might base my argument for coverage on the medicare rule that allows coverage for "therapeutic exercises which must be performed by or under the supervision of the qualified physical therapist, due to either the type of exercise employed or the condition of the patient". (Medicare benefit policy manual 40.2.2)
I'd be interested if anyone else has pursued this and hope this info helps anyone who might want to.
SUehttp://www.cms.gov/Medicare/Medicare-Fe ... tSheet.pdfhttp://www.medicareadvocacy.org/self-he ... d-denials/