Saturday, January 24, 2015

Moving your Medicare Appeal to the Front of the Line

Medicare beneficiaries continue to be erroneously denied the coverage to which they are entitled. Despite court rulings and regulations to the contrary we are finding that many nursing facilities continue to deny residents Medicare payment based on the discredited “improvement standard.” 
Under the law, Medicare benefits should depend on whether the patient can improve, but on whether skilled care is required and whether the services themselves are reasonable and necessary. See Downfall of the Medicare Improvement Requirement will Benefit Many.
Observation Status problems are also a growing concern for seniors who receive hospital treatment. If you need nursing home care after your hospitalization, it is very important that your hospitalization was an “inpatient admission.” (Medicare will only cover nursing home care after a 3-day inpatient hospital stay.) See Beware of Hospital "Observation Status."  
Medicare beneficiaries who are wrongly denied coverage have a right to appeal. But, until recently, pending appeals could be sunk for years in a Medicare bureaucratic bog. 
But there is some good news. A recent article written by Susan Jaffe and originally published by Kaiser Health News notes that while the number of appeals has been growing, wait times have been cut dramatically for Medicare beneficiaries.
Here is that article (reproduced with permission). 
Seniors’ Wait For A Medicare Appeal Is Cut In Half 
The federal office responsible for appeals for Medicare coverage has cut in half the waiting time for beneficiaries who are requesting a hearing before a judge.
The progress follows an announcement last January that officials were going to work through a crushing backlog by moving beneficiaries to the front of the line and suspending hearings on cases from hospitals, doctors and other providers for at least two years.

The Office of Medicare Hearings and Appeals (OMHA) has decided most of the 5,162 cases filed by beneficiaries in the fiscal year ending Sept. 30, plus 1,535 older cases, according to statistics provided to Kaiser Health News.
That’s a dramatic change from the year before, when a third of beneficiary cases (1,493) were not decided and nearly half (1,705) of the 2012 cases also were unresolved.
Still, about 900,000 appeals are awaiting decisions, with most filed by hospitals, nursing homes, medical device suppliers and other health care providers, said Jason Green, OMHA’s program and policy director. The wait times for health providers’ cases have doubled since last year, and are nearly four times longer than the processing time for beneficiary appeals.
Hospitals file more appeals than any other provider. The single largest reason is the increasing number of Medicare payment denials for patients who have been admitted to the hospital but whom auditors later say should have been kept instead for observation care, a status that reduces payments.
Seniors also have long complained about observation care because Medicare doesn’t cover follow-up nursing home care for observation patients.
The rise in beneficiary appeal decisions is a direct result of the “beneficiary-first” policy Chief Judge Nancy Griswold announced last January, said Green. The temporary measure will remain in place as long as there is a backlog, he added.
Since then, beneficiaries have waited 113 days on average for a hearing, compared to 235 days the year before, said Green. This includes appeals from beneficiaries in traditional Medicare and private Medicare Advantage insurance plans. It’s a big improvement but still not in compliance with the federal requirement that an appeal be decided within 90 days after a request for a hearing.
“We are striving toward that 90-day mark,” said Green, who expects the beneficiary appeals backlog will continue to shrink next year.
Reaching the Office of Medicare Hearings and Appeals (OMHA) is the third of four stages in the appeals process and the first opportunity for Medicare beneficiaries or health care providers to present their case before a judge. The odds of winning an appeal at the third stage are far better than at the previous levels, which involve only a review of the case files, the Health and Human Services inspector general has found.
But seniors seeking top priority treatment, must identify themselves by addressing their appeal to an OMHA office in Cleveland and writing “Attn: Beneficiary Mail Stop” on the envelope. Griswold announced the new mail address last February, and it is part of the instructions beneficiaries receive when their appeal is denied at the second level.
Beneficiary appeals filed before the new policy was established may be languishing in the backlog pile until officials find them.
“Beneficiaries can help us to help them get to the front of the line,” Griswold said at a meeting in October. She urged those beneficiaries to write to her office using the special mailing address or to call her office at 855-556-8475. 
This article was written by was produced by Kaiser Health News with support from The SCAN Foundation and originally published on December 23, 2014. Kaiser Health News (KHN) is a nonprofit national health policy news service.  
Other Resources, Claims & appeals
Center for Medicare Advocacy, Home Health

Monday, January 19, 2015

A Best Law Firm

We recently received notice that our law firm, Marshall, Parker and Weber, has been named to the list of best elder law firms in Pennsylvania for 2015. The award is made by US News Best Lawyers®. We were also named to this list last year. [Here is a link to information on the selection method:].  

I was individually recognized as one of the best elder law attorneys in the Commonwealth for 2015.
There are many fine elder law attorneys in Pennsylvania. We understand that being named to the top tier of elder law firms (as one of only 8 law firms in the state) is not just an honor – it’s a responsibility.
It is special to me to have received these recognitions this year – 2015 – because this year will see the 35th anniversary of the founding of Marshall, Parker and Weber. Back in 1980 I had no idea what would grow from the seed I was planting. How remarkable it has been to watch it develop into one of the most respected elder law and estate planning law firms in Pennsylvania. It is reason to celebrate. 
2015 is also the year when I reach age 70. This means I have reached the government defined maximum “retirement age” and have to start drawing on my Social Security and retirement plan benefits. This makes this feel like a watershed year.
As an elder law attorney I’ve helped so many clients plan for aging. And now I have arrived at an age where my own retirement plan is set to begin. I’ve become my own client. 
So, this year is a time of some culmination and much reflection for me. I realize now how fortunate I’ve been in my life and I say a prayer of thanks every day. I’ve had a wonderful loving family, a good education, and decent health. And I was particularly fortunate to have found a career path in elder law that I have loved and which has brought satisfaction and meaning to my life.
The occasional peer recognition, like Best Law Firms, is a small (but appreciated) bonus. Especially this year. 
I hope you will help us celebrate our 35th anniversary.  
Further Information 
Join us for Marshall, Parker and Weber’s 19th Annual Professional Update on May 6 or 7, 2015. Click here for more information: 

Saturday, January 17, 2015

Pennsylvania Aging Related Leaders Named

Governor–elect Tom Wolf has announced that he has chosen Teresa Osborne, who is the executive director of the Luzerne/Wyoming Counties Area Agency on Aging (AAA), to be secretary of the Pennsylvania Department of Aging. The Governor-elect also announced that he has chosen Ted Dallas, currently the secretary of the Maryland Department of Human Resources, to be his secretary of the Department of Human Services (formerly called the Department of Public Welfare).

Here is a link to the announcement of Ms. Osborne’s selection. And here is a link to the announcement regarding Mr. Dallas.

Teresa Osborne seems like an excellent choice to me. I’ve known her for years. She served as executive director of the Lackawanna County AAA before taking on the Luzerne County position. (My law firm has offices in both those counties). She is very knowledgeable, hard-working, smart, and an ardent advocate. Just what we need at the Department of Aging during challenging times.

The appointments are subject to approval by the Pennsylvania Senate.

Both of the Secretary-designates will need to work closely with the Legislature. Here is the current list of the 2015 chairs (Republican) and minority leaders (Democrat) of several legislative committees related to aging.

Senate Aging and Youth Committee:
Republican: Senator Michelle Brooks
Democrat: Senator Arthur Haywood
Committee Members listing: here

Senate Public Health and Welfare committee:
Republican: Senator Pat Vance
Democrat: Senator Shirley Kitchen
Committee Members listing: here

House Aging and Older Adult Services Committee:
Republican: Rep. Tim Hennessey, 26th Legislative District, Chester and Montgomery counties.
Democrat: Rep. Steve Samuelson, 135th Legislative District, Lehigh and Northampton counties.
Committee Members listing: here 

House Health Committee:
Republican: Rep. Matt Baker, 68th Legislative District, Bradford, Potter and Tioga counties.
Democrat: Rep. Florindo (Flo) Fabrizio, 2nd Legislative District, Erie County.
Committee Members listing: here 

Human Services Committee:
Republican: Rep. Gene DiGirolamo, 18th Legislative District, Bucks County.
Democrat: Rep. Angel Cruz, 180th Legislative District, Philadelphia County.
Committee Members listing: here

More information about the 2015-2016 PA General Assembly is available at:

Thursday, January 15, 2015

Lessons from a Marathon (Guest Post)

[One of the lawyers at my firm, Marshall, Parker and Weber, is a runner. Liz White recently completed the Marine Corps Marathon and drew some interesting estate planning lessons from her experience. She has given me permission to share her thoughts with readers of this blog.] 
My Marine Corps Marathon Experience: Develop and Trust Your Backup Plan
On October 26, 2014 I ran the 39th Annual Marine Corps Marathon in Washington, D.C. In addition to the honor of running amongst the thousands of Marines who volunteered their time and provided enthusiastic “OORAHs” along the course, I was privileged to run for a team called ALZ Stars. ALZ Stars is a group of athletes organized by the Alzheimer’s Association to participant in events, such as marathons and triathlons. As a team member I raised money for the Alzheimer’s Association for research, education, and awareness to help find a cure for Alzheimer’s disease.
This was not my first marathon, but I gained a significant lesson from this run. That lesson is that you need a plan, but more importantly, you need a backup plan.
I trained for months for the marathon. I wanted to beat my personal record by 10 minutes, and based on my training runs I was ready to achieve my goal. My race outfit, including my purple ALZ Stars jersey and my trusty running shoes, were packed. Nothing could stop me!
The morning of the race I waited in line with much anticipation to get on a shuttle bus that would take me and fellow runners to the start line. Unfortunately, the shuttle bus driver did not know how to get to the start line between the Pentagon and Arlington Cemetery. My adrenaline level started to hit a high, but not on the race course. Rather, I sat full of energy in a bus full of runners, circling the Pentagon for 35 minutes. Thankfully, a local runner on the bus was able to use the GPS on her phone to direct the shuttle driver to the start line.
As I finally exited the shuttle bus, I heard the Howitzer shot to start the marathon and saw Marines skydiving overhead with giant American flags. I enjoyed the occasion, but it hit me that there was no way I would be able to get through all the runners to start in my correct corral and begin at my planned race pace.
I spent the first 7 miles of the marathon weaving in and out of the masses of other runners to try to get to a group that were running at my planned pace. I was mentally exhausted from the stress of the bus ride and the stop and go of darting between runners. I looked down at my watch and saw I was not making up for lost time. At that moment, I knew it was time to reassess my plan. Today was not going to be the day to beat my personal best time. I had planned ahead, but you never know what life is going to throw in your path.
Thankfully, I had my backup plan ready. During training I had developed my backup plan in case an unforeseen situation occurred. My backup plan was to not give up, finish in the best time that I could, and to take the time to enjoy the run in front of me. I was running for an amazing organization in our Nation’s capital, with 30,000 people from all over the world. The sun was shining and spectators were cheering. I had many stories from co-workers and friends of their personal experiences with Alzheimer’s disease to motivate me. So, I stopped looking at my watch, trusted in my backup plan, and ran. I didn’t beat my personal record, but when the Marine at the finish line placed the medal around my neck, I smiled proudly. I was blessed to even have the ability to run 26.2 miles.

As I look back on the race, I realize the planning lesson I took from this experience is not only applicable to my marathon run. It is a great lesson for estate and life care planning.
First, you need goals to make up your estate and life care plan. Without goals you cannot even hit the ground running. There is little chance of achieving your goals if you haven’t thought about what your goals are or taken the time to communicate these goals. Everyone’s goals are different. Your goals can include to have the best person making health care and financial decisions for you if you are unable, to ensure your estate will pass to who you want it to when you pass away, and to express your wishes for care options in the future, whether that be in your home or at a preferred long-term care facility.
Next, your goals need to all come together to make up your personalized plan. Our office assists with your plan. Documents are drafted, beneficiaries named, accountants and financial advisors consulted, care providers contacted, and family members prepared. These steps create your plan, but you also need to address what happens if something in the plan changes.
Importantly, you need a backup plan. Don’t fear creating the backup plan. It is there for a reason. Life puts up roadblocks, usually when we least expect them. What if your spouse could not act as your agent regarding your health care decisions? You can plan to have a trusted successor agent named in your documents as a backup. What if a beneficiary of your estate predeceases you? You can outline in your will or trust who you would want that share of your estate to go to instead and name contingent beneficiaries on accounts. What if your children cannot relocate to where you live to care for you in your home? You can employ a care manager to coordinate care services for you. Plan for the best, but reassess. You may need to revisit your plan along the way.
Finally, as you develop your plan, make sure to take a moment to stop, stay in the present, take it all in, and run with it. As I learned during the marathon, when you are in control of your backup plan it can sometimes turn out to be even better than the original plan.