Some Helpful Links

Below are links to some websites that you may find helpful as you navigate the world of skilled nursing (sub-acute) rehab facilities and Medicare Advantage appeals.

https://medicare.gov
This is the official government Medicare website. You can find reviews for nursing homes and obtain lots of information about Medicare. It was useful when I filed appeals to find out more about how Medicare defines “skilled nursing” services.

U.S. News Best Nursing Homes 2022-2023
When I was doing research and trying to figure which facility I wanted to go to, this site was helpful in providing statistics on physical therapy and nursing at the facility in addition to star ratings and other info such as facility size and description .

A Google search for “nursing homes” or “nursing home reviews” will bring up reviews on many sites, including Yelp, Facebook, and several senior citizen oriented websites. Whenever you are reading reviews, be sure to read some recent ones. A “red flag” for me is whenever I start seeing mostly “padded” reviews by employees wanting to get in good with their employer. Watch out for that.

Publication #100-02 Medicare Benefit Policy Manual
When you receive appeal decision letters from the QIO (Qualified Improvement Organization) (in my geographic area, Kepro), these letters may contain citations from the Medicare Benefit Policy Manual. These citations are used by the QIO to support their decision on your appeal. The Medicare Benefit Policy Manual is an online resource used by insurance providers and QIOs. The link above is where you may download in .pdf file form the different manual sections. For skilled nursing rehab, you want to download Chapter 8. For home health care, download Chapter 7.

Center for Medicare Advocacy
The link above is to the website of an excellent non-profit organization called the Center for Medicare Advocacy. On this site you will find information about traditional Medicare vs. Medicare Advantage, appeals, and also an explanation of why the “improvement” (progress) standard should no longer be used. For more information on that, see the Jimmo v. Sebelius class action lawsuit topic on the Center’s website. Both my husband and I have spoken with people from this Center via phone. They have always been very understanding and helpful to us.

Kepro Case Status Tool
The link above is where you may check the status of your level 1 or level 2 appeal if your QIO is Kepro (Kepro is not in all states in the USA). To use this status checker, you will need the appeal case number. Just enter the case number into the tool’s box and then click or tap the “Search” button.