Advocate Underscores Senior Appeals Rights

Quality Improvement Organizations (QIOs) like IPRO are available to help seniors who wish to file expedited appeals of recent adverse Medicare coverage decisions, notes a blogger/columnist in the New York Times. Medicare policy revisions made in the wake of a settlement of the Jimmo federal class-action lawsuit specify that beneficiaries need not demonstrate ability to improve in order to receive skilled physical, occupational or speech therapy from nursing homes and home health agencies. Rather, seniors must only demonstrate a need for the services, regardless of their ability to improve. Seniors who believe they were denied coverage erroneously under the previous policy during the calendar year ending January 23, 2014 have until that date in 2015 to lodge an appeal. Appeal rights apply equally for enrollees in traditional Medicare as well as private Medicare Advantage plans, notes Times blogger Susan Jaffe. For additional information, seniors can call 1 (800) MEDICARE or go to the IPRO website under “Beneficiary Information, Know Your Rights, Request an Appeal” (http://qio.ipro.org/beneficiary-information/know-your-rights/request an appeal). The blog article, titled “A Quiet ‘Sea Change’ in Medicare,” published online March 25, 2014, is available at http://newoldage.blogs.nytimes.com.