News: Medicare continues to refuse payment for non-improving senior patients

Even after Medicare officials agreed that seniors cannot be denied coverage for physical therapy and other care based on their condition not improving, NPR News reported this week that patients are continuing to be turned away.

Several federal officials and Medicare advocates restarted their court battles to address the problem. “Many seniors have only been able to get coverage once their condition worsened. But once it improved, treatment would stop — until the people got worse and were eligible again for coverage,” the NPR article says.

Sometimes, providers assign a code which requires patient improvement and thus gets denied. Code assignment in these cases can not only ensure the proper reimbursement and coverage for the patient through CMS but ensure appropriate care gets provided at all.

"We still regularly get calls from people who are told they are being denied coverage," said Peter Schmidt at the National Parkinson Foundation in Miami, Florida says in the NPR report. In order to correct this problem, outside of the legal actions, further provider education will play a big role. Educating providers on how to code for treatment not predicated on the improvement standard could lead to greater coverage and better care for seniors.