Author Description

This book has been prepared for Medicare beneficiaries and others who need a relatively thorough explanation of the Medicare program with particular emphasis on services covered in institutional settings and services provided by physicians and suppliers. Published annually, this book includes changes made during 2009 by law and regulation amendments and updates to program manuals issued by the Centers for Medicare and Medicaid Services (CMS). The book includes analysis of legislative, regulatory and agency guidance issuance on the available benefits; exclusions from Medicare; the administration of the Medicare program; and Medicare payment rules under Parts A, B, C, and D. The book also details the process for submitting beneficiary claims as well as the appeals process. Updates to this edition include: Analysis of CMS's finalized procedures regarding the Medicare claims appeals process Revised and reorganized regulatory requirements for Part D plan sponsors, ALJs with respect to hearings, the MAC with respect to review of Part D appeals, and Part D enrollee rights New regulations implementing the Genetic Information Nondiscrimination Act of 2008