The Science Journal of the American Association for Respiratory Care

1997 OPEN FORUM Abstracts

Medicare Denials: The Provider's Perspective

Tami Carter, RRT, CPFT, Monday, December 8, 1997.

Objective: To help respiratory care practitioners work through a respiratory review of services from Medicare intermediaries in the Skilled Nursing facility setting.

Design: Report and analysis of actual focus review done in Oregon over a sixteen month period of time.

Measurements and Results: Statistics will be presented of, over 600 patients that were treated with respiratory therapy services and with a Medicare benefit. Of those 600 patients 5% per were denied coverage. Of the 5% denied, therapist have been able to turn some in the appeal process and others have been turned in the Administrative Law Judge process. (These statistics will be updated in November).

This presentation will walk a therapist through the process of Medicare asking for a "Request for Information" to the "Administrative Law Judge". A flow chart will be presented showing the therapist what to do at every step and explanation will be given for each step.

AARC 50th Anniversary, December 6 - 9, 1997, New Orleans, Louisiana.

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