What is a Complaint? A complaint is a statement that a situation is unsatisfactory or unacceptable. In healthcare, it can be about the quality of care you got or are getting. For example, you can file a complaint if you have a problem calling the plan, or you're unhappy with how a staff person at the plan treated you. What is an Appeal? An appeal is to make a serious or urgent request, typically to the public. You file an appeal if you have an issue with a plan's refusal to cover a service, supply, or prescription. Filing a Complaint If you have concerns about the quality of care or other services you get from a Medicare provider and if you are not satisfied, you can always file a complaint. How you will file depends on what your complaint is all about. It can either be: A doctor, hospital , or provider Your health or drug plan Quality of your care Your dialysis or kidney transplant care Durable medical equipment If you need help filing a complaint, you can contact ...

Medicare Supplement Plan F is a specific type of Medicare Supplement and is the most comprehensive of the standardized Medicare Supplement plans available in most states.  This Medicare Supplement, also called Medigap insurance may help pay for out-of-pocket costs of Medicare Part A and Part B. These costs can be coinsurance, copayments, or in some cases deductibles. Note: Medicare  Part  A and  Part  B make up the federal government’s Original Medicare program. Medicare Supplement plans are also named with letters but they are not the same thing. In 47 states, there are up to 10 Medicare Supplement plans that are standardized with lettered names and each standardized plan has the same set of basic benefits. This is what Medicare Supplement Plan F may cover: Inpatient hospital costs and coinsurance under Medicare Part A for an additional 365 days after Medicare coverage runs out Coinsurance for skilled nursing care facilities Medi...

NCOV-19 or COVID-19 or Novel Coronavirus is an infectious disease caused by a newly discovered coronavirus. People infected with NCOV-19 will likely to have mild to moderate respiratory illness. In older people, especially those who have underlying medical problems, a serious illness will likely arise. It starter in Wuhan, China and has spread dynamically to other countries, including the U.S. As of March 27, 2020 , there had been already a total of 85,612 confirmed cases of COVID-19 and total death of 1,301 . This included both confirmed and presumptive positive cases of COVID-19 reported or tested at CDC since January 21, 2020. President Trump declared on January 31, 2020, COVID-19 as a Public Health Emergency and also on that day, the 195 American evacuees from Wuhan, China undergo a federal quarantine for 14 days. HOW IS THIS TRANSMITTED? COVID-19 is believed to be transmitted person-to-person, between a person who is in close contact with one anoth...

Medicaid State Plan Fee-for-Service Payments for Services Delivered Via Telehealth  This document is intended to assist states in understanding policy options for paying Medicaid providers that use telehealth technology to deliver services. The overview and sample state plan language apply to Medicaid fee-for-service payments and additional considerations may be warranted for states interested in offering telehealth within other delivery systems. CMS encourages states to consider telehealth options as flexibility in combating the COVID-19 pandemic and increasing access to care. Overview of Fee-for-Service Telehealth  States are encouraged to facilitate clinically appropriate care within the Medicaid program using telehealth technology to deliver services covered under the State plan.  States have a great deal of flexibility with respect to covering Medicaid services provided via telehealth. States are not required to submit a State plan amendmen...

Telemedicine , for the purpose of Medicaid,  aims to improve a patient's health by allowing two-way, real-time interactive communication between the patient, and the physician or practitioner at the distant site. This would use interactive telecommunications equipment that includes, at a minimum, audio and video. It is a cost-effective alternative to the more traditional face-to-face way of providing medical care that states can choose to cover under Medicaid. This definition is modeled on Medicare's definition of telehealth services (42 CFR 410.78). Note that the federal Medicaid statute does not recognize telemedicine as a distinct service. Terms used in Telemedicine Distant or Hub site:  Site at which the physician or other licensed practitioner delivering the service is located at the time the service is provided via the telecommunications system. Originating or Spoke site:  Location of the Medicaid patient at the time the service being furnished via a...

1. How will recently enact legislation allow CMS to utilize Medicare telehealth to address the declared Coronavirus (COVID-19) public health emergency?  The Coronavirus Preparedness and Response Supplemental Appropriations Act, as signed into law by the President on March 6, 2020, includes a provision allowing the Secretary of the Department of Health and Human Services to waive certain Medicare telehealth payment requirements during the Public Health Emergency (PHE) declared by the Secretary of Health and Human Services January 31, 2020 to allow beneficiaries in all areas of the country to receive telehealth services, including at their home.  2. What does this mean? What payment requirements for Medicare telehealth services are affected by the waiver?  Under the waiver, limitations on where Medicare patients are eligible for telehealth will be removed during the emergency. In particular, patients outside of rural areas, and patients in their homes will be elig...

TELEHEALTH ACCESS DURING NCOV-19 PUBLIC HEALTH EMERGENCY CMS announced   several waivers and policy changes to broaden access to telehealth services for Medicare beneficiaries during the COVID-19 public health emergency. These include:  Waivers of originating and geographic site restrictions on Medicare telehealth services, permitting the delivery of these services in all areas of the country and all locations, including patients' homes. The ability of providers to use expanded telehealth authority for new and established patients for diagnosis and treatment of COVID-19, as well as for conditions unrelated to the pandemic. Permission for providers to use everyday communications technologies, such as FaceTime or Skype, during the COVID-19 public health emergency, without running afoul of HIPAA penalties. They also released a  frequently asked questions  document about the changes included in its announcement. ...

I have ESRD. Am I eligible for Medicare? You can apply for Medicare no matter how old you have all of these: ·          Your kidneys no longer work ·          You need regular dialysis or have had a kidney transplant ·          One of these applies to you: ·        You've worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee ·        You’re already getting or are eligible for Social Security or Railroad Retirement benefits ·     You’re the spouse or dependent child of a person who meets either of the requirements listed above. You may contact  Social Securit y  for more information. If you get benefits from the Railroad Retirement Board (RRB), call 1-877-772-5772. I’m on kidney dialysis or ...