A long-standing myth has prevented many seniors from obtaining necessary services under the Medicare program. Medicare contractors have long believed that a patient has to be “improving” in order to continue to obtain services. However, “improvement” is not now, nor has it ever been part of the applicable legal standard. Rather, if a patient needs therapy in order to maintain his or her current status, the service will be covered by Medicare. This issue has been litigated and last year, the Center for Medicare and Medicaid Services (CMS) settled a lawsuit, promising to do a better job educating contractors and adjudicators that no “improvement standard” exists. CMS agreed in the settlement to launch an educational “Jimmo” website. The website is now online.
The myth of the improvement standard is popular in Southwest Florida. I have often heard how patients were discharged from a rehabilitation facility long before their possible maximum covered period because they had “plateaued” or were “not improving.” Be aware that “improvement” is not needed to continue Medicare services. Read more about this topic here.
If you or one of your loved ones may be discharged from rehabilitation for failure to improve, do not hesitate to give our office a call.