Articles and Blogs

Executive Summary Hall, Render, Killian, Heath & Lyman is forming a group appeal relating to a negative payment adjustment made by CMS and implemented in the Federal Fiscal Year (“FFY”) 2014 Final Inpatient Prospective Payment System (“IPPS”) rule published August 19, 2013.  By this rule, CMS decreased IPPS payments to hospitals by 0.2% to offset... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) issued a Survey & Certification Memo (“S&C Letter”) to state agencies detailing the result of the governmental shutdown on long-term care providers as it relates to surveys.  As of this writing, the S&C Letter has not been published or otherwise made publicly available, and the below... READ MORE

On August 19, 2013, the Centers for Medicare and Medicaid Services (“CMS”) published in the Federal Register the 2014 acute care hospital and long-term care hospital inpatient prospective payment system final rule (“Final Rule”) effective on October 1, 2013.  As part of the Final Rule, CMS formulated a “2-midnight presumption” and a “2-midnight benchmark”... READ MORE

On August 15, 2013, the Office of the Inspector General for the Department of Health and Human Services (“OIG”) released a report titled “Most Critical Access Hospitals Would Not Meet the Location Requirements if Required to Re-enroll in Medicare” (“Report”).  If the recommendations in the Report are fully carried out, it could cause nearly two-thirds... READ MORE

Following the recent CMS Administrator’s Ruling CMS-1455-R, CMS issued a Program Transmittal with claims processing instructions related to the rebilling of denied inpatient claims under the interim rebilling policy.  A corresponding article intended for hospitals was released on March 22, 2013 and can be found on the CMS website here. READ MORE

The Medicare Payment Advisory Commission’s (“MedPAC”) recent Report to Congress included a chapter dedicated to skilled nursing facilities (“SNFs”), which MedPAC reports received $31 billion in Medicare reimbursement in 2011.  Recently, SNFs have been under pressure from repeated reimbursement cuts; however, MedPAC’s analysis states that SNF reimbursement is adequate.   READ MORE

The Medicare Payment Advisory Commission’s (“MedPAC”) March 25th Report to Congress outlines inefficiencies they believe exist in the post-acute world and lead to excessive Medicare payments to providers. MedPAC recommendations include Congress evaluate post-acute provider reimbursement and encourage use of the lowest cost mix of services necessary to achieve the best outcomes. READ MORE

Executive Summary On November 15, 2012, the Federal District Court of the District of Columbia issued a decision favorably impacting disproportionate share hospital (“DSH”) patient percentage (“DPP”) calculations.  If this decision is upheld on appeal, Medicare Advantage days may be removed from the SSI/Medicare Fraction (defined below) of the DPP calculation, thereby typically increasing... READ MORE

The U.S. Supreme Court has eliminated the possibility of a provider trying to claim additional Medicare cost report reimbursement under the legal theory of equitable tolling in its opinion published today: Sebelius v. Auburn Regional Medical Center (“Auburn”).  The result of this opinion places even more importance on ensuring providers adhere to the statutorily... READ MORE

Executive Summary This is the second in a series on Medicare Disproportionate Share Hospital (“DSH”) payment issues and is designed to provide hospitals with a practical approach for determining if they want to pursue different DSH appeal issues. On September 11, 2012, CMS posted the 2010 DSH-SSI (Supplemental Security Income) ratios.  As reported previously... READ MORE