To provide effective service in helping people understand how they are going to be affected by health care reform and how to obtain coverage, pursue an appeal, or plan for long-term care or retirement, you need the most current information from a source you can trust - Medicare Handbook. This is the indispensable resource for clarifying Medicare's confusing rules and regulations. Prepared by an outstanding team of experts from the Center for Medicare Advocacy, it addresses issues you need to master to provide effective planning advice or advocacy services, including: Medicare eligibility rules and enrollment requirements; Medicare covered services, deductibles, and co-payments; coinsurance, premiums, penalties; coverage criteria for each of the programs; problem areas of concern for the advocate; grievance and appeals procedures. The 2021 Edition of Medicare Handbook offers expert guidance on: Medicare Enrollment and Eligibility Medicare Coverage in all Care-Settings Medicare Coverage for People with Chronic Conditions Medicare Home Health Coverage and Access to Care Medicare-Related COVID Changes Prescription Drug Coverage Medicare Advantage Plans Medicare Appeals Health Care Reform And more! In addition, Medicare Handbook will help resolve the kinds of questions that arise on a regular basis, such as: How do I appeal a denial of services? What steps do I need to take in order to receive Medicare covered home health care? What are the elements of Medicare's appeal process for the denial of coverage of an item, service, or procedure? Does my state have to help me enroll in Medicare so that I can get assistance through a Medicare Savings Program? When should I sign up for a Medigap plan? If I am enrolled in Medicare, do I have to buy health insurance in the insurance marketplace created by the Affordable Care Act? Is it true that I have to show medical improvement in order to get Medicare for my nursing and therapy services? And more! The 2021 Medicare Handbook is the indispensable resource that provides: Extensive discussion and examples of how Medicare rules apply in the real world Case citations, checklists, worksheets, and other practice tools to help in obtaining coverage for clients, while minimizing research and drafting time Practice pointers and cautionary notes regarding coverage and eligibility questions when advocacy problems arise, and those areas in which coverage has often been reduced or denied And more! Note: Online subscriptions are for three-month periods. Previous Edition: Medicare Handbook, 2020 Edition ISBN 9781543811360

The Model Rules of Professional Conduct provides an up-to-date resource for information on legal ethics. Federal, state and local courts in all jurisdictions look to the Rules for guidance in solving lawyer malpractice cases, disciplinary actions, disqualification issues, sanctions questions and much more. In this volume, black-letter Rules of Professional Conduct are followed by numbered Comments that explain each Rule's purpose and provide suggestions for its practical application. The Rules will help you identify proper conduct in a variety of given situations, review those instances where discretionary action is possible, and define the nature of the relationship between you and your clients, colleagues and the courts.

Recoup lost time and revenue with denials management and appeals know-how. Claim denials can sink a profit margin. And given the cost of appeals, roughly $118 per claim, not all denials can be reworked. A practice submitting 50 claims a day at an average reimbursement rate of $200 per claim should bring in $10,000 in daily revenue. But if 10% of those claims are denied, and the practice can only appeal one, they lose $800 per day—upwards of $200K annually. Your medical claims are the lifeblood of operations. Don’t compromise your financial health. Learn how to preempt denials with the Denials Management & Appeals Reference Guide. This vital resource will equip you to get ahead of payers by simplifying the leading causes of denials and showing you how to address insufficient documentation, failing to establish medical necessity, coding and billing errors, coverage stipulations, and untimely filing. Rely on AAPC to walk you through the appeal process. We’ll help you establish protocols to avoid an appeals backlog and teach you how to identify and prioritize denials likely to win an appeal. What’s more, you’ll learn when a claim can be “reopened” to fix a problem. Collect the revenue your practice deserves with effective denials and appeals solutions: Know how to analyze your denials Defeat documentation and compliance issues for successful claims success Utilize payer policy for coverage clues Lock in revenue with face-to-face reimbursement guidance Refine efforts to avoid E/M claim denials Ace ICD-10 coding for optimum reimbursement Put an end to modifier confusion Stave off denials with CCI edits advice Navigate the appeals process like a pro And much more!

The Denials Management Training Handbook (Pack of 5) Tanja Twist, MBA/HCM Many hospitals struggle with denials management thanks to the complex regulations and various types of denials. Payers often send denials to the wrong person, and hospitals may lose valuable research and appeals time as a result. In addition, drafting effective appeals letters that follow Medicare's regulations can be time-consuming and difficult even for experienced staff. Worst of all, the hard work of managing denials and submitting appeals on the back end can all be wasted if there is no system to use denials data to address root causes on the front end. The Denials Management Training Handbook provides clear, concise explanations of the complex appeal guidelines for Medicare and other payers. This information is presented in an easy-to-understand handbook for distribution to staff members involved in preventing and handling appeals. This handbook will help you manage the denials management process by: Providing an overview of common denial types and appeal timelines Giving you sample forms and templates Exploring best practices for improving the denials management process throughout the revenue cycle Gliding in the use of denials data to track recurrent denials and address their causes

Medicare beneficiaries are rapidly moving into managed care, as attempts to restrain the growth of this costly entitlement program progress. However, advocates for patients question whether the necessary information and structures are in place to enable Medicare consumers to select wisely among private-sector managed care options. Improving the Medicare Market examines how to give Medicare beneficiaries the same choice of health plan options enjoyed in the private sectorâ€"yet protect them as consumers and patients. This book recommends approaches to ensuring accountability and informed purchasing for Medicare beneficiaries in an environment of broader choice and managed careâ€"how the government should evaluate and approve plans, what role the traditional Medicare program should play, how to help to elderly understand their options, and many other practical matters. The committee discusses the information requirements of Medicare beneficiaries and explores in detail how best to respond to their special needs. And it examines the procedures that should be developed to provide the necessary protections for the elderly in a managed care system.