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LYMPHEDEMA AND MEDICARE

This page has been updated and replaced by our new Wiki page.

Please see: Lymphedema and Medicare

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_medicare

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Medicare - Information

If you become disabled you may qualify for Social Security and Medicare benefits. This section will help in understanding the maze you have to face, how to deal with it, file for it and knowing how to appeal decisions.

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Medicare - Home Page

http://www.medicare.gov

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Medicare Managed Care

APPEALS AND GRIEVANCES

https://www.cms.gov/MMCAG/

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Medicare Rights Center

http://www.medicarerights.org/

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How to Find Medicare Information

http://www.ssa.gov/pgm/mediinfo.htm

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Medicare-Approved Drug Discount Cards

http://www.medicare.gov/medicarereform/CMS-20016-E.pdf

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Medicare and Home Health Care

http://www.medicare.gov/publications/pubs/pdf/10969.pdf

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MEDICARE AND LYMPHEDEMA -- HOW IT CAME TO BE

Florida Protocol

JOHN M. MacDonald, M.D., F.A.C.S.

http://lymphedemahelp.org/detail.asp?ci=43&it=IPI

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Medicare Plan Choices

http://www.medicare.gov/navigation/medicare-basics/coverage-choices.aspx

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Medicare-Medicaid Program Coordination Initiatives

http://www.cms.gov/home/medimedi.asp

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Medicare Therapy Coverage for Lymphedema

Getting Medicare to recognize lymphedema therapy as essential medical expenditure has been a difficult task. Lymphedema patients have been long trying to get the benefit of Medicare for the expenses that they incur for the therapy that continues throughout their life. The Women's Health and Cancer Rights Act states that complications arising due to breast cancer surgery, which includes lymphedema, must be covered by all insurance providers. However, this coverage does not extend to those who suffer from primary or secondary lymphedema. In February 2008, the compression garments considered an essential part of lymphedema therapy were classified as covered items for Medicare.

Lymphedema is a condition that has no medical cure, although it can be managed with therapy which is known as the Complete Decongestive Therapy or CDT. The process involves a lymphatic massage combined with the use of compression bandages and compression garments, a skin care routine and a regular exercise regimen. The most important aspect of the therapy is the manual lymph drainage (MLD) which aims at draining the stagnated lymph to reduce the swelling. Occasionally, the therapist might use the Sequential Gradient Pump to loosen fibrotic tissues before the massage. The therapist performing the lymphatic massage is a specialized professional trained in the technique. Therapy sessions in the early stages may be held frequently, at least five days a week. Those who do not have easy access to the lymphedema therapist may use a sequential gradient pump for the lymphatic drainage process.

Medicare covers the lymphedema pump therapy, but recently the coverage rules have been modified. Previously, although the pneumatic compression devices were included in coverage, the patient had to attempt all other methods of treatment first, a process that took many months. This has changed now. Compression devices have been included under durable medical expenses for both primary and secondary lymphedema. There is a four-week trial period which the doctor must observe. A course of medication, use of compression garments and elevation of the limb is followed by the patient and if no improvement is seen, the doctor prescribes a pneumatic pump. The doctor is required to give a Certificate of Medical Necessity to enable the patient to procure a lymphedema pump from a Medicare authorized supplier. The supplier of the pump must be enrolled with Medicare and possess the Medicare Supplier Number, or you will not be reimbursed the claim.

In case of compression garments, which can be a large recurring expense, lymphedema sufferers have had to deal with legislatures which prevented their inclusion in Medicare coverage lists. A positive judgment in February 2008 has come to the aid of lymphedema patients. Compression garments were classified as items meeting the standards for covered items. Items like compression bandages, compression sleeves and stockings were considered medically essential and would be covered as prosthetic devices under Medicare for lymphedema therapy. The lymphedema patients can take advantage of this edict and claim a compensation for these medically essential items that help them to manage the lymphedema.

Peter Hodges has been studying the lymphatic system and how to heal it vigorously since 2003. After many years of research he has now discovered how to heal the lymphatic system, reduce lymphedema swelling and return the body to optimal health.

http://ezinearticles.com/?Medicare-Therapy-Coverage-For-Lymphedema&id=3324896

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Medicare Allowances for Lymphedema Pumps

http://oig.hhs.gov/oei/reports/oei-04-97-00130.pdf

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Medicare & Medicaid

Medicare New or Changed Policies 2012

Program transmittals are used to communicate new or changed policies, and/or procedures that are being incorporated into a specific CMS program manual. The cover page (or transmittal page) summarizes the new changed material, specifying what is changed.

http://www.medicare.gov/default.

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Medicare: It’s Your Right

September 2003 newsletter for California
Medicare Beneficiaries, The Medicare Source Published Quarterly by NHIC, A CMS

CMRI is a nonprofit federally funded Quality Improvement Organization for
Medicare in the state of California. CMRI assists and advocates for Medicare
beneficiary rights and works with healthcare providers to improve the quality of
care Medicare beneficiaries receive.
When you have Medicare, you have the right to the care you need. You also
have the right to be fully informed and to be involved in decisions made about
your care. This means you also have the right to question decisions you think
aren’t best for you.

As a Medicare beneficiary there are other rights that are also assured to you:

* The right to protection from discriminating in marketing and enrollment
practices
* The right to information about what is covered and how much you have to
pay
* The right to all treatment options available to you
* The right to appeal decisions to deny or limit payment for medical care.
* The right to know how your Medicare health plan pays its doctors
* The right to choose a women’s health specialist
* The right, if you have a complex or serious medical condition, to receive
a treatment plan that includes direct access to a specialist
* The right to receive emergency care

CMRI’s services for Medicare Beneficiaries and their representatives are
free. Beneficiaries can contact CMRI to either appeal for a hospital discharge
notice or file a quality of care complaint.
If you are being discharged from a hospital before you are medically ready to
leave, talk with your doctor or discharge planner first. If your health care
provider cannot provide an extension of discharge for you, ask for the
decision in writing, sometimes called “Notice of Noncoverage” or “Denial Notice.”
Once you get the notice call CMRI by noon the next business day. CMRI will
appeal the decision and review the case. While the case is being reviewed by
CMRIs’ medical staff, the Medicare beneficiary can stay in the hospital and
Medicare will cover the additional days until a decision is made.
CMRI can also help if a Medicare beneficiary has concerns about the quality
of healthcare received in all settings of care. If you feel your healthcare has
been put at risk because of poor care, call CMRI and we will review the care
you received and send you our findings in writing. If we find there was a
problem, we will work with that provider to improve the care they give to patients
in the future.
CMRI works continuously with Medicare healthcare providers across California
to implement statewide best practices for Medicare beneficiaries.
CMRI has a toll-free multilingual Helpline. A live customer service
representative will answer your call during business hours, M-F 9:00 a.m. to 4:00 p.m.
1-800-841-1602. TTD line for the hearing impaired 1-800-881-5980. During
non-business hours, you may leave a message and a Customer Service Representative
will contact you the next business day.

For more information: 1-800 Medicare or 1-800-633-4227
CMRI encourages healthy partnerships for quality care; It’s your Right.

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Womens' Health and Cancer Rights Act of 1998 (WHCRA).

In a message dated 11/4/03 7:37:15 PM, Dyanna & Jay writes:

<<If you develop LE as a result
of cancer treatments the cancer patient's rights act
(Bob Weiss for details, pretty sure I got the name
wrong) mandates that insurance companies must cover
treatment of LE as a result of the original cancer
treatment. If it is primary (the default diagnosis
for an undetermined etiology) then you are NOT
guaranteed coverage. This is a pet peeve of mine, so
it's probably just as well my email ate my first
reply... If you develop LE, make sure it's labelled
as 2ndary by your doc to get coverage...>>

The law that Dyanna & Jay refer to is the Womens' Health and Cancer Rights
Act of 1998 (WHCRA). Only about half of the states have passed state legislation
that complies with the Federal law. There are three things you can do to help.

1. Urge that your Congressional representatives (your two Senators and
Representative) fix the WHCRA and, if your state has not passed compliance
legislation, then do it.

2. Request that your Congressional representatives (your two Senators and
Representative) sponsor a new law to mandate lymphedema treatment and save
Medicare millions of taxpayer money every year. I can provide you with a proposed
law ready for their sponsorship.

3. Request that your State Senators and State Assemblyman sponsor a state law
for the treatment of lymphedema from all sources, primary and secondary. I
have the text of the new Virginia Law, the proposed Masschusetts bill, and a
proposed California bill, plus support materials.

Contact me for materials for you to give to your representatives.

Bob Weiss
LymphActivist

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Medicare Determination Manual

https://www.cms.gov/manuals/downloads/ncd103c1_Part4.pdf

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Internet Resources for Accurate Coding and Reimbursement Practices (Updated)

http://library.ahima.org/xpedio/idcplg?IdcService=GET_HIGHLIGHT_INFO&QueryText=(5010%2Ctransactions)++<AND>++(xPublishSite<substring>%60BoK%60)&SortField=Score&

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Medicare and Compression Garments

http://www.lymphedemapeople.com/wiki/doku.php?id=medicare_and_compression_garments

Medicare and Compression Pumps

http://www.lymphedemapeople.com/wiki/doku.php?id=medicare_and_compression_pumps

Medicare Appeal Procedure for Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=medicare_appeal_procedure_for_lymphedema

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For information about Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema\

For Information about Lymphedema Complications

http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_lymphedema

For Lymphedema Personal Stories

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=3

For information about How to Treat a Lymphedema Wound

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound

For information about Lymphedema Treatment 

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment

For information about Exercises for Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema

For information on Infections Associated with Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema

For information on Lymphedema in Children

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children

Lymphedema Glossary

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing

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Lymphedema People - Support Groups

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Children with Lymphedema

The time has come for families, parents, caregivers to have a support group of their own. Support group for parents, families and caregivers of chilren with lymphedema. Sharing information on coping, diagnosis, treatment and prognosis. Sponsored by Lymphedema People.

http://health.groups.yahoo.com/group/childrenwithlymphedema/

Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com

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Lipedema Lipodema Lipoedema

No matter how you spell it, this is another very little understood and totally frustrating conditions out there. This will be a support group for those suffering with lipedema/lipodema. A place for information, sharing experiences, exploring treatment options and coping.

Come join, be a part of the family!

http://health.groups.yahoo.com/group/lipedema_lipodema_lipoedema/?yguid=209645515

Subscribe: lipedema_lipodema_lipoedema-subscribe@yahoogroups.com

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MEN WITH LYMPHEDEMA

If you are a man with lymphedema; a man with a loved one with lymphedema who you are trying to help and understand come join us and discover what it is to be the master instead of the sufferer of lymphedema.

http://health.groups.yahoo.com/group/menwithlymphedema/

Subscribe: menwithlymphedema-subscribe@yahoogroups.com

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All About Lymphangiectasia

Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.

http://health.groups.yahoo.com/group/allaboutlymphangiectasia/

Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com

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Lymphatic Disorders Support Group @ Yahoo Groups

While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.

DISCRIPTION

Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of information available through sister site Lymphedema People.

http://health.groups.yahoo.com/group/lymphaticdisorders/

Subscribe: lymphaticdisorders-subscribe@yahoogroups.com

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Lymphedema People New Wiki Pages

Have you seen our new “Wiki” pages yet?  Listed below are just a sample of the more than 140 pages now listed in our Wiki section. We are also working on hundred more.  Come and take a stroll! 

Lymphedema Glossary 

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing 

Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema 

Arm Lymphedema  

http://www.lymphedemapeople.com/wiki/doku.php?id=arm_lymphedema 

Leg Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=leg_lymphedema 

Acute Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=acute_lymphedema 

The Lymphedema Diet 

http://www.lymphedemapeople.com/wiki/doku.php?id=the_lymphedema_diet 

Exercises for Lymphedema  

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema 

Diuretics are not for Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=diuretics_are_not_for_lymphedema 

Lymphedema People Online Support Groups 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_people_online_support_groups 

Lipedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=lipedema 

Treatment 

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment 

Lymphedema and Pain Management 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pain_management 

Manual Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT)

http://www.lymphedemapeople.com/wiki/doku.php?id=manual_lymphatic_drainage_mld_complex_decongestive_therapy_cdt 

Infections Associated with Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema 

How to Treat a Lymphedema Wound 

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound 

Fungal Infections Associated with Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=fungal_infections_associated_with_lymphedema 

Lymphedema in Children 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children 

Lymphoscintigraphy 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphoscintigraphy 

Magnetic Resonance Imaging 

http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging 

Extraperitoneal para-aortic lymph node dissection (EPLND) 

http://www.lymphedemapeople.com/wiki/doku.php?id=extraperitoneal_para-aortic_lymph_node_dissection_eplnd 

Axillary node biopsy 

http://www.lymphedemapeople.com/wiki/doku.php?id=axillary_node_biopsy

Sentinel Node Biopsy 

http://www.lymphedemapeople.com/wiki/doku.php?id=sentinel_node_biopsy

 Small Needle Biopsy - Fine Needle Aspiration 

http://www.lymphedemapeople.com/wiki/doku.php?id=small_needle_biopsy 

Magnetic Resonance Imaging 

http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging 

Lymphedema Gene FOXC2

 http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_foxc2

 Lymphedema Gene VEGFC

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_vegfc

 Lymphedema Gene SOX18

 http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_sox18

 Lymphedema and Pregnancy

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pregnancy

Home page: Lymphedema People

http://www.lymphedemapeople.com

Page Updated: Jan. 02, 2012