As part of the January 2013 class-action settlement agreement that prevents Medicare from denying coverage to beneficiaries for skilled nursing, physical, occupational, and speech-language therapy services solely for lack of improvement, a “Re-review” process was created to help determine if some prior claims were improperly denied.
What is the Re-Review Process?
The process was officially launched by the Center for Medicare and Medicaid Services (CMS) on January 24, 2014. It allows a Medicare beneficiary to request a CMS review of a therapy services-related claim that was already denied because of the Improvement Standard. Revisions to the Medicare policy manual now make it clear that Medicare coverage may be available for skilled nursing or therapy services to maintain a person’s condition.
Who is Eligible?
A Medicare beneficiary may be eligible for re-review if he or she:
How Do I Apply for a Re-Review?
It is solely up to you as the beneficiary to ask CMS for a Re-Review. There is now a form on the CMS website  to help get the process started. The form includes a few introductory questions to help you determine whether your claim may be eligible for Re-Review and contact information if you need additional assistance.
The Center for Medicare Advocacy also has great information and resources  on how the Re-Review process is designed to work.
There is only a limited window to ask CMS to Re-Review your denied therapy services claim. Here are two key dates to keep in mind.
Date originally posted: February 7, 2014.