{"id":11287,"date":"2019-04-03T16:23:08","date_gmt":"2019-04-03T21:23:08","guid":{"rendered":"https:\/\/hammerle.com\/?p=11287"},"modified":"2020-02-21T08:29:32","modified_gmt":"2020-02-21T14:29:32","slug":"jimmo-revisited-improvement-vs-need-medicare-standard","status":"publish","type":"post","link":"https:\/\/hammerle.com\/legaltalk\/news\/jimmo-revisited-improvement-vs-need-medicare-standard\/","title":{"rendered":"Jimmo Revisited: Improvement vs. Need Medicare Standard"},"content":{"rendered":"

You need to know about Jimmo because many Medicare providers, suppliers, and adjusters are clueless.<\/h2>\n

So says a 2018 report from the Centers for Medicare & Medicaid Services.<\/h3>\n

Jimmo<\/a> is the name for a 2013 settlement arising from a federal lawsuit over Medicare coverage for skilled nursing care and skilled therapy services.\u00a0 The Jimmo agreement restated the standard for providing continued services.\u00a0 Providers and suppliers who do not know about Jimmo are prone to wrongfully cut off services and refuse to supply equipment because, frankly, they are applying the wrong standard.<\/p>\n

That is where you come in. You have to know the basics so you can fight a wrongful denial.<\/h2>\n

So here are the basics:<\/h3>\n

Medicare provides services for skilled nursing or therapy to a \u201cbeneficiary\u201d under its skilled nursing facility, home health, and outpatient benefits.\u00a0 The beneficiary has to initially qualify for the benefits, including meeting the requirements that the services be reasonable and necessary, comply with therapy caps and not exceed the 100- day limit for Part A SNF benefits during the benefit period.<\/p>\n

Here is where Jimmo comes in:<\/h3>\n

Medicare cannot refuse to provide these benefits merely because the beneficiary has no potential for improvement.\u00a0 It simply does not matter whether the care is expected to improve or maintain the beneficiary\u2019s clinical condition.<\/p>\n

For services furnished in an Inpatient Rehabilitation Facility or a comprehensive outpatient rehabilitation facility, Jimmo clarifies that coverage should never be denied merely because the beneficiary cannot be expected to achieve complete independence of self-care or return to a prior level of functioning.<\/p>\n

Because of Jimmo, nursing and therapy services must be provided to maintain the beneficiary\u2019s condition or prevent or slow further deterioration.\u00a0 Coverage turns on the beneficiary\u2019s need for skilled care.<\/p>\n

To qualify for coverage, the beneficiary must have an individualized assessment of his or her medical condition and the reasonableness and necessity of the treatment, care or services.<\/p>\n

To get that, a health care provider must do the evaluation.\u00a0 Here is where it gets a bit tricky.\u00a0 The health care provider has to keep adequate documentation.\u00a0 Cryptic notes such as \u201cpatient tolerated treatment well,\u201d \u201ccontinue with POC,\u201d and \u201cpatient remains stable\u201d won\u2019t cut it.<\/p>\n

Beneficiaries will have to continue obtaining evaluations throughout their treatment.<\/h3>\n

The Jimmo standards also apply to Medicare patients whose health care providers are in Accountable Care Organizations and to beneficiaries of Medicare Advantage plans.<\/p>\n

If you have questions, there are several good resources available.\u00a0 The beneficiary helpline is at\u00a0 1-800-MEDICARE.\u00a0 A CMS question and answer sheet can be found at https:\/\/www.cms.gov\/Center\/Special-Topic\/Jimmo-Settlement\/FAQS.html<\/a>.<\/p>\n

A general discussion can be found at https:\/\/www.cms.gov\/center\/special-topic\/jimmo-center.html<\/a>.\u00a0 That website also provides you with a link to the text of the Jimmo Settlement Agreement.<\/p>\n

If you want to dazzle your provider, then casually mention the Medicare Benefit Policy Manual (100-02) and state he or she needs to brush up on Chapters 7, 8 and 15 and then come back and discuss it with you.<\/p>\n

Knowledge is power.\u00a0 Now that you have it, use it.<\/h3>\n

Virginia Hammerle<\/a> is a licensed Texas attorney.\u00a0 Her practice includes estate planning<\/a>, litigation<\/a>, guardianship<\/a>, and probate law<\/a>. \u00a0See hammerle.com<\/a> for her blog<\/a> and newsletter sign-up.\u00a0 This column does not constitute legal advice.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

You need to know about Jimmo because many Medicare providers, suppliers, and adjusters are clueless. So says a 2018 report from the Centers for Medicare & Medicaid Services. Jimmo is the name for a 2013 settlement arising from a federal lawsuit over Medicare coverage for skilled nursing care and skilled therapy services.\u00a0 The Jimmo agreement […]<\/p>\n","protected":false},"author":5,"featured_media":11731,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"categories":[26],"tags":[1033,280],"class_list":{"0":"post-11287","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-news","8":"tag-healthcare","9":"tag-medicare"},"yoast_head":"\nJimmo Revisited: Improvement vs. Need Medicare Standard - Hammerle Morris Law Firm<\/title>\n<meta name=\"description\" content=\"Jimmo is the name for a 2013 settlement arising from a federal lawsuit over Medicare coverage for skilled nursing care and skilled therapy services.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/hammerle.com\/legaltalk\/news\/jimmo-revisited-improvement-vs-need-medicare-standard\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Jimmo Revisited: Improvement vs. Need Medicare Standard - 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