Practice Issues Forum: Does Medicare Really Cover Maintenance Therapy?
Session Code: NE-3A-5622
Date: Saturday, February 7, 2015
Time: 8:00 AM - 10:00 AM
Location: JW Marriott
Room: Grand Ballroom 2
Session Type: Educational Sessions
Session Level: Multiple Level
The final settlement in the class action Improvement Standard lawsuit Jimmo v Sebelius upheld the right of Medicare beneficiaries to continue to receive reasonable and necessary care to maintain their condition and prevent or slow decline. As a result of the settlement, Medicare intermediaries were directed to update their local coverage determinations removing language that may have unfairly denied services based on an arbitrary improvement standard. This session will explore all of the issues associated with the improvement standard lawsuit, the settlement, and impact on practice. Clinicians will share real-life examples of how they have managed patients under these updated provisions. There will be opportunity for discussion and sharing of ideas with members of the audience.
1. Describe the peripheral resource and central benefits of skilled care and formal exercise for persons with chronic conditions.
2. Discuss the class action improvement standard lawsuit Jimmo v Sebelius and its impact on physical therapist practice.
3. Describe patient situations that have benefitted from the change in local coverage determinations associated with the lawsuit.
4. Describe strategies for documenting maintenance care in order to be reimbursed.
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