CMS Giveth and Taketh Away: New CMS Ruling on Medicare DSH Payments


On April 28, 2010, CMS issued a sweeping ruling that will affect many hundreds of hospitals, and thousands of cost years, with

disproportionate share hospital (DSH) reimbursement challenges. The Ruling, CMS-198-R, addresses three specific DSH issues: (1) the data matching process employed by CMS in calculating the days in the Supplemental Security Income (SSI) fraction; (2) prior to October 1, 2004, the exclusion from the Medicaid fraction of Medicare secondary payor (MSP) days and days for which a patient’s Part A inpatient hospital benefit days were exhausted (exhausted days); and (3) prior to October 1, 2009, the exclusion of labor/delivery room inpatient days from the DSH computation. For cases presenting these issues, the Ruling requires the administrative body – whether it be the Provider Reimbursement Review Board, the CMS Administrator, or the CMS reviewing official – to remand the appeal to the appropriate Medicare contractor for recomputation. Thomas W. Coons of Ober|Kaler discusses.

LOADING PDF: If there are any problems, click here to download the file.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Baker Donelson | Attorney Advertising

Written by:


Baker Donelson on:

Readers' Choice 2017
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:

Sign up to create your digest using LinkedIn*

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.

Already signed up? Log in here

*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.