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THE RIGHT TO APPEAL A DECISION

It's important to know that patients have the right to appeal a Medicare decision. However, if you're refusing services recommended by your physician, you'll need to check with your doctor regarding potential health repercussions. If you accept services, you may not be required to pay for them, as Medicare may cover the payments. However, once a claim is sent to Medicare, you may be billed while a decision is being made on your case. If Medicare does pay, you will be refunded in full. If payment is denied, you will be responsible for full payment.

MEDICARE WAIVER OF LIABILITY

Also known as the Advance Beneficiary Notice, the Medicare Waiver of Liability basically protects patients. As a patient, it gives you the opportunity to either accept or refuse various items or services and protects you from getting stuck with a hefty bill that you weren't expecting due to Medicare denying payment.

It's important to know that when you sign a Medicare Waiver, that you automatically become "on the hook" for payment - either out-of-pocket or through an insurance company.

Patients have been known to receive frequent ABN notices. In these cases, certain items are only covered up to a certain number of times by Medicare. If you receive a notice like this, it means that typically you'll need this service multiple times, but that it may not be covered each time.

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Blog Post of the Month

CMS extends Medicaid waiver in Massachusetts

December 20, 2011

By Sam Baker

The federal government on Tuesday extended a Medicaid waiver in Massachusetts, which was first implemented as part of then-Gov. Mitt Romney's healthcare overhaul.  (Full Story)

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