Robert Weiss, MS
This instructional session will attempt to orient the lymphedema practitioner within the patchwork world of health insurance. The many sources of health insurance, governing laws and statutes, regulatory authorities and appeal processes will be presented as an introduction to the most influential of all insurers-Medicare.
A general overview of Medicare will discuss the statutory basis of Medicare, Title XVIII of the Social Security Act (SSA), benefit categories of interest to the lymphedema community, implementation of the statutes by the Centers for Medicare and Medicaid Services (CMS), coding and billing authorities, and the ever-important Medicare appeal system. Medicare coverage of lymphedema treatment will be outlined, compared with current recommended guidelines and gaps and conflicts identified.
Recent changes in Medicare law and policy will be discussed from the point of view of impact on lymphedema community, and advocacy activities on behalf of lymphedema patients will be updated. Activity relating to changing CMS policy within the current statutes as well as legislative activity to change the law with new legislation will be updated to the week of the conference. Updates will be presented on Medicare appeals and recent Administrative Law Judge decisions concerning the coverability of compression bandages, garments and devices as "prosthetic devices" under §1861(s)(8) of the SSA.
A current update will be presented on Federal and State bill activities which will have an impact on lymphedema treatment coverage in the future, and what can be done to influence this legislation.