Thomas W. Coons

Thomas W. Coons


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CMS Prevails in Dual Eligible Bad Debt Challenge

In a decision handed down on August 7, 2015, the United States Court of Appeals for the District of Columbia Circuit upheld the denial of the providers' bad debt claims associated with dual eligible beneficiaries. Grossmont...more

9/5/2015 - Appeals Bad Debt CMS Co-Insurance Payments Deductibles Dual Beneficiaries Filing Deadlines Hospitals Medi-Cal Medicaid Medicare Provider Reimbursement Manual

CMS Waves Partial White Flag in Appeals of Payment Status Denials

For the last several years, hospitals, on the one hand, and the Centers for Medicare and Medicaid Services and its contractors (collectively, CMS), on the other, have been engaged in a spirited dispute over claims denials for...more

9/8/2014 - Administrative Appeals Claim Procedures CMS Final Rules Hospitals Inpatient Prospective Payment System (IPPS) Medicaid Medicare OMHA

CMS Publishes FY 2015 Final IPPS Rule

On August 4, 2014, CMS posted its final changes and updates to the Medicare Inpatient Prospective Payment System (IPPS) that apply for fiscal year (FY) 2015, effective October 1, 2014. Below are some of the highlights of the...more

8/12/2014 - CMS Final Rules Hospitals Inpatient Prospective Payment System (IPPS) Long Term Care Facilities Medicaid Medicare Physician Medicare Reimbursements

Medicare's LTCH Moratorium - CMS Issues Instructions and Proposed Regulation

From the early 1980s until the end of the first decade of the 21st century, the number of long-term acute care hospitals (LTCHs) expanded many fold. Addressing this growth, Congress, in enacting the Medicare, Medicaid and...more

6/6/2014 - CHIP CMS Healthcare Healthcare Reform Hospitals Long Term Care Facilities Medicaid Medicare

CMS Proposes Significant Changes and Clarifications in OPPS Proposed Rule

In its OPPS proposed rule published July 19, 2013 [PDF], at Fed. Reg. 43534-43707, CMS proposed significant changes and clarifications to its current policy. Among the most notable changes are the four discussed below...more

7/24/2013 - CMS Healthcare Hospitals Medicaid Medicare Physicians

Court of Appeals Hands Down Significant DSH Ruling

As we reported in a Payment Matters article dated February 16, 2012, early last year the United States District Court for the District of Columbia handed providers a significant victory in Catholic Health Initiatives-Iowa v....more

6/28/2013 - CMS DSH Healthcare Medicaid Medicare

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

Court of Appeals Rules for Government in DSH Exhausted Benefit Day Appeal

For the last several years, hospitals and the government have fought hard over where days associated with certain “dual eligible” patients should be placed in the Medicare disproportionate share hospital (DSH) calculation. At...more

4/5/2013 - DSH Health Insurance Medicaid Medical Reimbursement Medicare Medicare Advantage

Extension of Time for Overpayment Recoveries in Fiscal Cliff Law Not as Broad as it Sounds

The recently passed fiscal cliff legislation, i.e., the American Taxpayer Relief Act of 2012 (Act) [PDF], includes a number of provisions addressing Medicare and Medicaid. One of these provisions extends the recovery period...more

1/18/2013 - American Taxpayer Relief Act CMS Extensions Fiscal Cliff Medicaid Medicare OIG Overpayment Reopening Laws Social Security Act

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