Medicare appeals for further PT

[Anonymous]

Has anyone been successful with getting Medicare to approve more PT in a nursing home? My parent has not made progress after a hip replacement, and the first appeal with Levanta was denied. We’ve been told we can appeal again to another company, but does anyone have any advice how to get that one to approve further PT?

My parent was not able to engage in PT at the nursing home, die to not getting pain meds before sessions and suffering with a UTI during the time period allotted.

Thanks.

[Anonymous]

I've not heard much about success, but go for it, especially if you are able to document.

[Anonymous]

In the appeal state that getting more PT is much cheaper than paying for the consequences of another fall or other medical conditions which could result from being bedridden.

[Anonymous]

Are they now better able to engage in PT and work toward reachable rehab goals? Is so, I’d appeal again. I’ve never seen a successful appeal at the hospital level but the cases have not been as strong as what you describe here (which sounds like a change in status/functionality?).

Are you trying to extend their rehab stay/prevent them from going home, or do they now reside in the nursing home? If the latter, another option (which is expensive) is to hire their in-house PT for a few sessions and then have them train family to assist in exercises that can be safely performed seated or at bedside.

But I’m surprised that the rehab team is not on board with re-attempting PT now that the UTI is treated. It’s possible that they didn’t want to administer pain meds before therapy due to potential drowsiness/risk for falls - I’m wondering what they gave communicated to you.

If your parent is going home, Medicare will cover the cost of home PT and again, family/caregivers can be trained to assist, if possible.

But if Levanta already denied your appeal, I would be prepared for another denial. When you call to appeal, ask them what your options are and how you can best advocate for your parent, because the company that manages appeals is an outside agency that is unaffiliated with Medicare.

Good luck.

[Anonymous]

Thanks. She has been in the nursing home for several years and is back there now. I will try my appeal.