Medicare Compliance & Reimbursement
RURAL HOSPITAL TRUMPS FEDS ON DSH
Rural facilities may be more likely to qualify for disproportionate share hospital payments than they think. Witness the case of District Memorial Hospital of Southwestern North Carolina in Andrews, NC, which on May 12 scored a legal victory against the Department of Health and Human Services over how swing bed days factor into DSH calculations. At issue in the case was whether days during which swing beds were utilized may be included in the calculation of patient days for DSH purposes. The hospital said yes, based on regulatory language under which patient days should be tallied in "areas of the hospitals that are subject to the prospective payment system." The hospital reasoned that "areas" means just what it says: geographic areas of the hospital. HHS countered that "areas" has a more far-reaching, if more esoteric, definition that would exclude swing beds. In District Memorial Hospital v. Thompson (No. 2:01CV259C), the U.S. District Court for the Western District of North Carolina nixed HHS' broader - and more nebulous - take on the rule, maintaining that the agency is bound by the plain meaning of the regulation which, in the end, HHS itself wrote. That finding means District Memorial will be entitled to more than $600,000 in DSH payments that had previously been rejected. Lesson Learned: Small providers who fight back against distorted takes on reimbursement rules can prevail - if they're persistent.
Medicare Compliance & Reimbursement
- Reimbursement:
TAX BILL: STATES GET HELP, BUT RURAL PROVIDERS MUST WAIT
States will get $20 billion in new federal money under the economic growth package passed [...] - Medicaid:
COMMERCE NAMES MEDICAID TASK FORCE
In search of Medicaid revisions to enhance the program and save cash, House Energy and [...] - Medicare+Choice:
2004 PAYMENT RATES OFFER LITTLE HELP TO STRUGGLING M+COS
Will this be the straw that breaks Medicare+ Choice's back or the final insult that [...] - Medicare+Choice:
SOCIAL HMO PROGRAM COULD BE NEARING END
Medicare+Choice plans that have wanted to get in on Medicare's social HMO demonstration may never [...] - Pharmaceuticals:
DRUG REBATE EXPERIMENT WEATHERS HIGH COURT CHALLENGE
A state program that could point toward lower reimbursement for the nation's drugmakers came one [...] - Long-Term Care:
MEDICAID SHORTFALLS BODE ILL FOR NURSING HOMES' BOTTOM LINES
The sunset of Medicare add-on payments last year, looming therapy caps, proposed bad-debt reimbursement changes [...] - Labs:
WHAT TO EXPECT ON CLIA SURVEYS -THIS QUARTER
Good news for clinical labs: The Centers for Medicare & Medicaid Services is keeping surveyors [...] - Hospitals:
HOSPITALS MUST BEEF UP POST-ACUTE TRANSFER COMPLIANCE
Hospitals with high error rates for post-acute transfers could be in for aggressive enforcement actions [...] - Hospitals:
RURAL HOSPITAL TRUMPS FEDS ON DSH
Rural facilities may be more likely to qualify for disproportionate share hospital payments than they [...] - Physicians:
SPECIALTY HOSPITALS FEEL THE HEAT
The compliance ground rules for physician-owned specialty hospitals could be in for a major shakeup. [...] - Hospitals:
GETTING IT RIGHT ON OPPS MULTIPLE-PROCEDURE CLAIMS
A hospital's misunderstanding of outpatient prospective payment system billing rules has caught the attention of [...] - PROGRAM MEMO ROUNDUP
Health care providers who've been shortchanged on services involving mammography-related computer aided detection equipment may [...] - BILL WATCH
The following House bills were introduced: H.R. 2151. A bill to amend title XVIII of [...] - REGISTER WATCH
Arkansas and Michigan will each get another chance to argue for state plan amendments previously [...]
