Marietta Medicaid & Elder Law

06/29/2023

THIS 🤍🖤

06/13/2023

Who is the angel that sent this? Wow!!!

05/25/2023

05/11/2023

Wonderful!

05/03/2023

Those were the Day's

05/03/2023

May is and the 2023 theme is . Join us this month in embracing the opportunity to continue to change. Find a new passion, go on an adventure, and push boundaries by not letting age define your limits.

05/03/2023

Happy Jewish American Heritage Month to all our Jewish American friends and community members! This month, we celebrate the rich history, culture and values of Jewish Americans that helped shape our country. Let us take this opportunity to learn more about Jewish traditions, honor the resilience of the Jewish people, and continue to promote inclusion and diversity in our society.

07/14/2022

Big Win for Medicare Recipients –Appeals Process Now Available

Medicare is a federal program that provides medical coverage to certain individuals –those over age 65, younger folks with disabilities, and people with End Stage Renal Disease.

This coverage is critical to get those populations needed care. Medicare Part B covers things like doctor’s visits and outpatient care; it is not free.

Medicare Part A provides coverage for hospital stays, certain stays in a long-term care facility, and some types of home health care. It is provided at no cost for individuals who have paid Social Security taxes for a proscribed amount of time. In order for Medicare Part A to cover long-term care facility costs, certain requirements have to be met. The patient must have days left in their benefit period and also have a qualifying hospital stay. A qualifying hospital stay generally means that the patient must have been admitted to the hospital for three days. The important thing is that the patient cannot be classified as observation status during those three days. If the requisite conditions are met, the patient can qualify for thirty days of care in a long-term care facility. The long-term care needs must relate to the reason the patient was in the hospital and the patient must enter the long-term care facility within a short time, usually about 30 days, from leaving the hospital. What often happens is that a hospital will change a patient’s classification from being an admitted patient to observation status and thus thwart the patient’s ability to receive their 30 days of care within a long-term care facility.

Eleven years ago, a lawsuit was filed to challenge this practice and to provide an appeals process when a patient’s status gets changed from inpatient to observation. After more than a decade, the litigation has culminated into a ruling that was recently issued by the United States Court of Appeals for the Second Circuit. The lawsuit was filed by a slew of patients (or their estates) who had their status at the hospital changed without their consent and thus resulted in benefits for their subsequent care at a long-term care facility being denied.

The reason that hospitals often change a patient’s status from inpatient to observation is how the hospital can bill Medicare. If the hospital admits the Medicare patient as inpatient status but the claims representative from Medicare doesn’t agree that the patient should be of that status, then Medicare will not reimburse such claim. In addition, in order for Medicare to pay for a claim for observation status, there has to be a doctor’s order stating that the patient should be in observation status. And such doctor’s order cannot be done retroactively. So, if an inpatient claim is denied, the doctor cannot go back and write an order saying the patient was in observation status and rebill Medicare.

Let’s go through an example. Edna was admitted to the hospital as inpatient status and stayed three days. Thereafter, the hospital bills Medicare and the claim was denied, stating that Edna should not have been classified as inpatient. Because Edna’s doctor did not write an order during her stay that indicated she was in observation status (she was in inpatient status, after all), then the hospital has no recourse to bill Medicare because a doctor’s order for observation status cannot be retroactive. The hospital is left holding the bag for Edna’s care. This conundrum led to many hospitals to prefer to list a patient as being in observation status, just to be sure they could get paid through a Medicare claim. But, as discussed, classifying a patient as observation status has adverse effects on that patient being able to get their subsequent long-term care paid for through Medicare.

Enter the recent court ruling. The court in this case found that when patients are reclassified as observation status from inpatient status, there should be a way to appeal that decision. The patient should get a say on whether they feel the decision is fair and give reasons or evidence on why the reclassification should not occur. This case is a big win for Medicare patients and will pave the way for them to have more control over their care and benefits. Sources:

07/14/2022

2022 Brings the Latest in Testing and Treatments for Alzheimer’s Disease

Alzheimer’s disease gradually destroys memory and other mental functions that cause confusion. Many of us have a friend, family member, or know of someone that has been diagnosed. The medical community continues to search for ways to relieve symptoms, test for early signs, and find a cure.
Studies have shown that changes in learning and memory happen well before signs of Alzheimer’s are found in brain scans. Early detection could offer an opportunity for preventative treatment in the future.
Testing for Earlier Diagnosis
Recently, The US Food and Drug Administration (FDA) authorized the first in vitro diagnostic for early testing of Alzheimer’s disease. It is an alternative to (PET) scans that use radiation and cerebrospinal fluid taps that are costly and time-consuming.
In May 2022, Fujirebio Diagnostic developed a new testing application for patients 55 years and older who have shown cognitive impairment. The test was able to get through an expedited review process. It can be used to detect brain plaques and analyze spinal fluid and proteins that accumulate to form the amyloid-beta plaques tied to Alzheimer’s disease. The FDA suggests testing be combined with other clinical evaluations to confirm a diagnosis.
Doctors and Medical Labs Evaluate the Future of Alzheimer’s
Most primary care doctors believe that one day, dementia will be managed as a chronic disease. But that means doctors and patients need to be made aware of new treatments and technologies, like the test developed by Fujirebio Diagnostic.
A survey by the Harris Poll for Quest Diagnostics suggests half of physicians don’t think Alzheimer’s will ever be cured, but about 75% thought new therapies might help manage the disease. Quest introduced a blood test in March for the early detection of Alzheimer’s. The company wants to see physicians and patients begin to prepare for the newer, more convenient diagnostics to become widespread tools in the health care industry.
Diagnostic blood tests would be faster and more cost-effective for the healthcare system overall and lead to a more immediate referral to specialists. However, the majority of clinicians also feared the blood tests for Alzheimer’s would cause a surge in diagnoses and stress the health care system.
New Alzheimer’s Drugs that Change Disease Progression and Relieve Symptoms
The FDA approved the first treatment to slow the progression of Alzheimer’s disease, aducanumab (Aduhelm), in 2021, although Medicare will only cover patients participating in clinical trials. This drug may benefit both cognition and function.
Other medications can only treat symptoms:
• Cholinesterase inhibitors like Donepezil, Rivastigmine, and Galantamine are prescribed to treat symptoms related to memory, language, judgment, and other thought processes at different stages of the disease.
• Glutamate regulators like Memantine can improve memory, reason, language, attention, and the ability to perform simple tasks. Some of these drugs are used in combination for moderate to severe Alzheimer’s disease.
• Orexin receptor antagonists like Suvorexant can help with insomnia in Alzheimer’s patients.
Quest reports that more than 100 disease-modifying therapies are now in clinical trials, with nearly 20 in later stages. With all the new technology to help physicians evaluate patients’ Alzheimer’s risk and disease progression, the future of Alzheimer’s may change from a debilitating illness to a manageable one. For those of us who have friends or family members with the disease, there is hope to slow the development and better manage the symptoms.

Sources:
https://www.mcknights.com/news/clinical-news/fda-first-of-its-kind-diagnostic-test-for-alzheimers-gets-green-light/
https://www.raps.org/news-and-articles/news-articles/2022/5/first-in-vitro-diagnostic-for-early-alzheimers-det #:~:text=On%204%20May%2C%20FDA%20announced,who%20have%20shown%20cognitive%20impairment
Managing Alzheimer’s as chronic disease will require clinician, patient education, docs say
Subtle cognitive problems may reveal Alzheimer’s far earlier than thought
First Alzheimer’s commercial blood test to detect amyloid beta hits the market

The US Food and Drug Administration (FDA) has authorized the first in vitro diagnostic to help diagnose early Alzheimer’s disease. The agency said the test minimizes radiation risks to patients who otherwise would need to be tested with positron emission tomography (PET) scans.

05/12/2022

Big Win for Medicare Recipients –Appeals Process Now Available Medicare is a federal program that provides medical coverage to certain individuals –those over age 65, younger folks with disabilities, and people with End Stage Renal Disease. This coverage is critical to get those populations needed care. Medicare Part B covers things like doctor’s visits and outpatient care; it is not free. Medicare Part A provides coverage for hospital stays, certain stays in a long-term care facility, and some types of home health care. It is provided at no cost for individuals who have paid Social Security taxes for a proscribed amount of time. In order for Medicare Part A to cover long-term care facility costs, certain requirements have to be met. The patient must have days left in their benefit period and also have a qualifying hospital stay. A qualifying hospital stay generally means that the patient must have been admitted to the hospital for three days. The important thing is that the patient cannot be classified as observation status during those three days. If the requisite conditions are met, the patient can qualify for thirty days of care in a long-term care facility. The long-term care needs must relate to the reason the patient was in the hospital and the patient must enter the long-term care facility within a short time, usually about 30 days, from leaving the hospital. What often happens is that a hospital will change a patient’s classification from being an admitted patient to observation status and thus thwart the patient’s ability to receive their 30 days of care within a long-term care facility. Eleven years ago, a lawsuit was filed to challenge this practice and to provide an appeals process when a patient’s status gets changed from inpatient to observation. After more than a decade, the litigation has culminated into a ruling that was recently issued by the United States Court of Appeals for the Second Circuit. The lawsuit was filed by a slew of patients (or their estates) who had their status at the hospital changed without their consent and thus resulted in benefits for their subsequent care at a long-term care facility being denied. The reason that hospitals often change a patient’s status from inpatient to observation is how the hospital can bill Medicare. If the hospital admits the Medicare patient as inpatient status but the claims representative from Medicare doesn’t agree that the patient should be of that status, then Medicare will not reimburse such claim. In addition, in order for Medicare to pay for a claim for observation status, there has to be a doctor’s order stating that the patient should be in observation status. And such doctor’s order cannot be done retroactively. So, if an inpatient claim is denied, the doctor cannot go back and write an order saying the patient was in observation status and rebill Medicare. Let’s go through an example. Edna was admitted to the hospital as inpatient status and stayed three days. Thereafter, the hospital bills Medicare and the claim was denied, stating that Edna should not have been classified as inpatient. Because Edna’s doctor did not write an order during her stay that indicated she was in observation status (she was in inpatient status, after
all), then the hospital has no recourse to bill Medicare because a doctor’s order for observation status cannot be retroactive. The hospital is left holding the bag for Edna’s care. This conundrum led to many hospitals to prefer to list a patient as being in observation status, just to be sure they could get paid through a Medicare claim. But, as discussed, classifying a patient as observation status has adverse effects on that patient being able to get their subsequent long-term care paid for through Medicare. Enter the recent court ruling. The court in this case found that when patients are reclassified as observation status from inpatient status, there should be a way to appeal that decision. The patient should get a say on whether they feel the decision is fair and give reasons or evidence on why the reclassification should not occur. This case is a big win for Medicare patients and will pave the way for them to have more control over their care and benefits. Sources: