One of our mang care contractors told us CMS had issued a new memoradum regarding
denial notices.There was a class action legal suit where the people bringing forth the
suit said M+medicare providers were denying their rights.Tommy Thompson agreed with
them.In Massachusetts[not sure of the other states]will have an expedited process.The
snf must give the bene notice 48 hours before the managed care provider.In
Mass,Masspro,who is our QI contractor,they are involved with the quality initiative
program in our state I think will be notified by us if the bene wants to appeal.My
understanding is that Masspro will be in within 24 hours to review the appeal.I think
the Mass Federation of Nsg Homes has given us the direction we should go.the managed
care case worker iniatially told me this process would be for all med A patients.I had
been trying to get clarification from anyone on list srver but my administrator gave
me the instructions from the Federation this past Wed as the iniatitive should start
Jan 1st..I would assume this CMS direc
tive is a national issue but each state may handle it differently as they did with the
Quality Initiative program
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