Real-World cases
We have included just a few real-world case examples of how AffirMD Advocacy has helped advocate for clients and their families, and made true, tanigble, positive changes in their healthcare journeys.
1
Skilled Nursing Facility (SNF) Denial Appeal Support
Challenge: Post-hospital discharge client was sent to a skilled nursing facility, required 5 day-per-week comprehensive skilled therapy services. Medicare denied SNF coverage, creating risk for an unsafe discharge and urgent advocacy services were required by the client and their family.
AffirMD Approach: Performed a detailed review of medical records and denial language, helped the client fully understand the care course, denial and AffirMD Advocacy's role in the appeal process. Aligned the appeal to medical necessity, and Centers for Medicare & Medicaid (CMS) skilled care requirement criteria, and drafted several structured comprehensive appeal statements within an expedited timeframe.
Result: Coverage denial initially overturned after appeal, allowing continuation of SNF care while the next steps for patient care were determined.
Services: Medical records review · SNF/Medicare denial appeal support · Medical necessity documentation · Care coordination
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