Wednesday

10:00 am - 11:30 am

W17: 

Corporate Compliance and the Mythical Medicare Improvement Standard

Level: Intermediate

The Jimmo vs Sebelius case challenged Medicare’s use of an “improvement standard” in determining medical necessity for skilled nursing services and outpatient therapy on the grounds that it violated Medicare law and deprived Medicare beneficiaries of needed care. Under the settlement of the class action lawsuit, Medicare coverage to perform a maintenance program does not depend on the presence or absence of a beneficiary’s potential for improvement, but on the beneficiary’s need for skilled care. This presentation will provide information about the landmark settlement, identify key corporate/facility operations impacted by the settlement, and provide data analytics for related key outcomes.

 

Nancy J. Augustine, Senior HealthCare Specialist
PointRight Inc.
2013 Champion Partner

Sheila G. Capitosti, VP of Clinical and Compliance Services
Functional Pathways