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How the "Improvement Standard" Improperly Denies Coverage to Medicare Patients with Chronic Conditions

By Gill Deford, Margaret Murphy & Judith Stein

Advocates working on behalf of Medicare beneficiaries should be aware of the so-called improvement standard and how it denies those suffering from chronic conditions the Medicare coverage to which they are otherwise entitled. The standard is found solely in the Centers for Medicare and Medicaid Services manual and has no basis in Medicare statutes or regulations, yet it is routinely applied by Medicare contractors. Litigation has proven to be effective when dealing with this issue, and advocates can benefit from understanding the legal strategies involved. 

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