Hospitals, CMS | JD Supra Law News

Bringing Sunlight to Healthcare Pricing: The CMS Release of Hospital Charge Data

by Robert Wolin | BakerHostetler on 5/17/2013

Former U.S. Supreme Court Justice Louis D. Brandeis once said that "Sunlight is the best disinfectant." The release of charges billed by some 3,337 Medicare hospitals for 100 of the most common inpatient diagnosis related...more

CMS Posts Hospital Charge Data

by King & Spalding on 5/16/2013

On May 8, 2013, Secretary of the Department of Health and Human Services (HHS), Kathleen Sebelius, announced the posting by the Center for Medicare & Medicaid Services (CMS) of hospital-specific charges for the more than...more

Health Reform + Related Health Policy News - May 2013

by Jane Arnold, Colleen M. Faddick, Sara Iams, Matthew Murer, Alan K. Parver, Tennille Syrstad | Polsinelli on 5/13/2013

In This Issue: - Top News ..HHS Releases Hospital Pricing Data in Transparency Effort; Results Show Significant Variation ..States Divided on Medicaid Expansion ..CMS Issues FY 2014 Proposed Rules for...more

Recent Court Decisions Affecting DSH Percentage Calculations May Impact Participation in the 340B Drug Discount Program

by Christine Morse | Ober|Kaler on 5/3/2013

A number of recent developments affecting the Disproportionate Share Hospital (DSH) percentage calculation methodologies will likely have significant impact on 340B covered entities. DSH hospitals that participate in the 340B...more

CMS Releases Proposed Inpatient Payment Regulation

by King & Spalding on 5/2/2013

On April 26, 2013, CMS released the proposed 2014 payment schedule for inpatient stays at general acute care and long-term care hospitals. In addition to the annual adjustment to payment rates, the proposed rule also reduces...more

CMS Proposes Prospective Payment System Update Rules for Inpatient and Long Term Care Hospitals

by Colin Roskey | Cozen O'Connor on 5/2/2013

On Friday, April 26, the Centers for Medicare and Medicaid Services (CMS) issued a crucial payment system rule that proposes updated rates and regulatory policies for inpatient hospitals (including inpatient psychiatric...more

CMS Releases Proposed FFY 2014 IPPS Rule

by Mark A. Stanley | Ober|Kaler on 5/2/2013

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

CMS Issues Proposed Changes to LTCH Payment Rates and Other Payment Policies for Fiscal Year 2014

by Paul Pitts | Reed Smith on 5/2/2013

On April 26, 2013, the Centers for Medicare & Medicaid Services (“CMS”) released the proposed update to the Medicare long-term acute care hospital prospective payment system (“LTCH PPS”) policies and payment rates for fiscal...more

Hospitals Prevail in Effort to Include Pennsylvania GA Days in the Medicare DSH Calculation

by Gregory Fliszar, Mark Gallant | Cozen O'Connor on 5/1/2013

Two of Mercy Health System’s hospitals (Nazareth Hospital and the former St. Agnes Medical Center) successfully challenged, before Judge Ludwig of the U.S. District Court for the Eastern District of Pennsylvania, the...more

Significant Proposed Changes for Federal Health Care Programs in President’s Fiscal Year 2014 Budget Plan

by Elizabeth K. Isbey, Eric Zimmerman | McDermott Will & Emery on 4/19/2013

On April 10, 2013, President Obama released his budget proposal for fiscal year (FY) 2014 (the Budget). The President reiterated his long-standing goal of reducing the deficit by $4.3 trillion over 10 years and his...more

Health Reform + Related Health Policy News Update - April 2013

by Jane Arnold, Anika Clifton, Thomas Donohoe, Colleen M. Faddick, Matthew Murer, Alan K. Parver, Emily Wey | Polsinelli on 4/17/2013

In this Issue: - Top News ..Large Hospital Systems Settles for $25.5 Million for False Claims Act Allegations ..Catholics’ Challenge to Contraceptive Coverage Mandate Dismissed As Not Ripe - States...more

Part B Inpatient Billing in Hospitals

by Daniel Cody, Susan Edwards, Rachel Golick | Reed Smith on 4/8/2013

Introduction - On March 13, 2013, the Centers for Medicare & Medicaid Services (CMS) concurrently issued CMS Ruling Number CMS-1455-R (the Administrator’s Ruling) and a proposed rule, “Part B Inpatient Billing in...more

The New DSH - Are You Supplying The Correct Data That Will Drive Your Payments?

by Leslie Demaree Goldsmith | Ober|Kaler on 4/8/2013

Effective October 1, 2013, CMS will begin paying disproportionate share hospitals differently. Congress ordered the change to the disproportionate share hospital (DSH) adjustment payment methodology as part of the Patient...more

Court Places Limits on Secretary's "No Reopening" Arguments

by Thomas W. Coons | Ober|Kaler on 3/31/2013

CMS has often argued that “base year” determinations cannot be revisited once the three-year reopening period has closed. Now, a recent decision from the U.S. Court of Appeals for the District of Columbia Circuit places those...more

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

by Mark A. Stanley | Ober|Kaler on 3/30/2013

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

CMS Revises Part B Billing Policy for Unnecessary Inpatient Admissions

by Thomas W. Coons, Carel Hedlund | Ober|Kaler on 3/29/2013

For many years, CMS policy has been that, if an inpatient admission was denied for medical necessity reasons, the hospital could bill under Part B for only a limited set of services that, significantly, did not include...more

CMS Offers Partial Concession to Hospitals by Issuing Ruling, Proposed Rule on Part B Re-Billing

by Jason Caron, Elizabeth K. Isbey, Joan Polacheck, Eric Zimmerman | McDermott Will & Emery on 3/29/2013

The U.S. Centers for Medicare & Medicaid Services (CMS) recently released both a “ruling” and a proposed rule intended to address growing concern among hospitals about billing Medicare Part B following a medical necessity...more

CMS Hospital Inspection Report Database Creates More Transparency

by Stephanie Willis | Mintz Levin - Health Law on 3/22/2013

Transparency in healthcare reached a new level over the weekend when the Association of Healthcare Journalists (AHCJ) unveiled a searchable database of past Centers for Medicare & Medicaid Services (CMS) hospital deficiency...more

CMS Addresses Hospital Rebilling After Inpatient Denials Through Interim Administrator Ruling and Proposed Rule

by Darby C. Allen, B. Scott McBride | BakerHostetler on 3/22/2013

On March 18, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register two important documents addressing the hotly contested issue of a hospital's ability to obtain payment under Part B for...more

Hospitals Provided Temporary Relief In Medicare Rebilling Policy

by Madeline Engel, Renee M. Howard, David B. Robbins | Perkins Coie on 3/21/2013

The Centers for Medicare & Medicaid Services (CMS) released a ruling and an interim rule that, effective immediately, will allow hospitals to rebill certain inpatient hospital services as outpatient services for one year...more

Surprise! CMS-2567 Statement of Deficiencies Forms for Hospital Surveys Now Available Online

by Sandra DiVarco | McDermott Will & Emery on 3/20/2013

The Centers for Medicare & Medicaid Services (CMS) released survey findings from hundreds of hospital CMS-2567 forms to a nonprofit organization that has posted the information—without responsive plans of correction from the...more

Resubmission of Hospital Claims

by Thomas Hess, Tyler N. Williams | Dinsmore & Shohl LLP on 3/13/2013

On February 13, CGS Administrators, the Parts A and B Medicare Administrative Contractor for Kentucky and Ohio, relayed instructions to Medicare hospitals paid under the Inpatient Prospective Payment System from the Centers...more

CMS Announces Changes to Payment Adjustment for Low-Volume Hospitals and Medicare-Dependent Hospital Programs

by King & Spalding on 3/13/2013

In a March 7 notice, CMS announced changes to the payment adjustment for low-volume hospitals and the Medicare-dependent hospital (MDH) program under the hospital inpatient prospective payment systems for fiscal year 2013. ...more

CMS Issues Second Set of Proposed Rule in Response to Executive Order 13563

by Emily J. Cook, Sandra DiVarco | McDermott Will & Emery on 2/21/2013

The proposed rule, issued on February 7, 2013, would make reforms to existing Medicare regulations applicable to hospitals, ambulatory surgical centers, intermediate care facilities for individuals who are intellectually...more

CMS Issues Proposed Rule to Reform "Unnecessary, Obsolete, or Excessively Burdensome" Medicare Participation Standards

by Sarah Baker, Dinetia Newman | Bradley Arant Boult Cummings LLP on 2/20/2013

On February 4, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to reform Medicare regulations that CMS views as unnecessary, obsolete, and/or excessively burdensome on hospitals and health care...more

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