Mark A. Stanley

Mark A. Stanley

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CMS to Begin Implementing 25 Percent Threshold for LTCHs

CMS, in its federal fiscal year (FFY) 2014 final rule, has allowed its five-year moratorium on the 25 percent threshold payment adjustment policy to expire. Following the lifting of this moratorium, LTCHs that admit more than...more

8/30/2013 - CMS Healthcare Hospitals Long-Term Care Payment Plans

CMS Releases Proposed FFY 2014 SNF PPS Rule

CMS has released its proposed federal fiscal year (FFY) 2014 prospective payment system (PPS) rule for Medicare Skilled Nursing Facilities (SNFs). The rule projects a net increase in operating payments to SNFs in the amount...more

6/14/2013 - CMS Medicare Provider Payments Reporting Requirements SNF

CMS Releases Proposed FFY 2014 IPPS Rule

CMS has released its proposed federal fiscal year (FFY) 2014 prospective payment system (PPS) rule for inpatient stays in acute care and long-term care hospitals (LTCHs). The rule projects a net increase in operating payments...more

5/2/2013 - CMS Document Coding Healthcare Hospitals Long Term Care Facilities Long-Term Care Medicare Patient Prospective Payment System Proposed Regulation

Court Grants Unexpected Victory to Providers on Medicare DSH Adjustment

The United States District Court for the Eastern District of Pennsylvania’s opinion in Nazareth Hosp. v. Sebelius, slip op. no. 10-3513 furnished a surprising victory to two providers that challenged the calculation of the...more

4/18/2013 - CMS DSH Medicaid Medicare Patients

PRRB Upholds Liquidation Requirement for Pension Expenses in Wage Index Calculation

The Provider Reimbursement Review Board (PRRB) has issued a decision upholding CMS’s policy of not recognizing pension expenses for purposes of calculating the wage index unless such expenses are liquidated within one year. ...more

4/9/2013 - CMS GAAP Pension Expenses Pensions PRRB Wages

Payment Adjustments for Low-Volume Hospitals and Medicare-Dependent Hospital Program Extended

CMS has issued a notice that (1) payment adjustments for certain low-volume hospitals and (2) the Medicare-dependent hospital (MDH) program will be extended through federal fiscal year 2013 (FY 2013). The extension of the...more

3/30/2013 - Affordable Care Act CMS Hospitals Medicare

No Judicial Review of Contractor’s Finding of a High Payment Error Rate, a Condition for Extrapolation

Before a Medicare contractor can use extrapolation to determine an overpayment amount, the Medicare statute requires that it must make a finding that there is a sustained or high level of payment error or that documented...more

2/11/2013 - ALJ Appeals CMS Extrapolation High Payment Error Rate Independent Contractors Judicial Review Jurisdiction Medicare Medicare Appeals Council Overpayment QIC

AHA Survey Identifies Continuing Problems with Medicare RAC Program

The American Hospital Association (AHA) published its RACTRAC Survey results for the third quarter of 2012. The AHA created the survey in response to the lack of information released by CMS on its Medicare RAC program. For...more

1/25/2013 - American Hospital Association Appeals CMS Medicare RAC Program Surveys

CMS Releases its CY 2013 Physician Fee Schedule Final Rule

CMS has released its Calendar Year (CY) 2013 Final Rule for practitioners who are paid under the Physician Fee Schedule (PFS). CMS anticipates that many non-primary care specialties will see a decrease in payments under the...more

12/4/2012 - CMS Physician Fee Schedule

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