Checklist for Medicare Outpatient Therapy “Improvement Standard” Denials

Checklist for Medicare Outpatient Therapy “Improvement Standard” Denials

With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Checklist to help Medicare beneficiaries and their families respond to unfair Medicare denials for outpatient therapy based on an erroneous “Improvement Standard.” The Checklist outlines the coverage criteria for outpatient therapy and emphasizes language from the Jimmo Settlement Agreement. Per the Settlement, the Centers for Medicare & Medicaid Services (CMS) revised the Medicare Benefit Policy Manual to clearly disavow any notion that individuals receiving outpatient therapy must improve in order for their care to be covered by Medicare.

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