Hospitals Medicare

News & Analysis as of

Site-Neutral Billing Exemptions

The Balanced Budget Bill Act of 2015 has a site-neutral billing provision relating to off-campus hospital outpatient departments (HOPDs). Those are facilities away from the hospital campus but certified as part of the...more

Legal Issues Associated with Multi-Provider Alternative Payment Model

Since the passage of the Affordable Care Act (ACA), both federal and state policies have promoted the adoption of alternative payment models (APMs), providing financial incentives for groups of providers to improve care...more

Congress Considers Broader Hospital Site-Neutral Payment Exceptions and Other Payments Changes

In Depth - The House Ways and Means Committee next week is expected to consider and approve the Helping Hospitals Improve Patient Care Act of 2016, legislation that would create broader exceptions under much maligned...more

CMS's FTE cap-setting methodology: It pays to hog residents!

One of the chief concerns of a new teaching hospital as it begins training residents is establishment of its full-time equivalent (FTE) resident limit or, as it is commonly known, "FTE cap." Teaching hospitals' FTE caps...more

California Court Rules Medicare Does Not Preempt Hospital Claims Against Payer

On April 27, 2016, a California state court judge in a Complex Litigation department for the County of Los Angeles, ruled in favor of 13 of our hospital clients on an important matter involving substantive and financial...more

D.C. District Court Resolves Challenge to Medicare's Outlier Payment Rules for Banner Health v. Burwell

On March 31, 2016, Judge Colleen Kollar-Kotelly of the United States District Court for the District of Columbia (the “D.C. District Court”) issued a highly anticipated memorandum opinion settling what will probably be the...more

FY 2017 IPPS Proposed Rule Results in Modest Increase for Hospitals

CMS recently issued a proposed rule updating fiscal year (FY) 2017 Medicare payment policies and rates under the Medicare inpatient prospective payment system (IPPS) and the long-term care hospital (LTCH) prospective payment...more

CMS Proposes FY 2017 Update for Medicare IPPS, LTCH PPS Rates and Policies

CMS has published its proposed rule to update the Medicare acute hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (PPS) for fiscal year (FY) 2017....more

Seeing your first Medicare GME dollars

Hospitals that decide to begin training residents and become new teaching hospitals often wonder when they will start to receive Medicare graduate medical education (GME) funding. Will the money come in the door the first day...more

CMS Finalizes Updated Fire Safety Standards for Health Care Facilities

On May 4, 2016, CMS is publishing a final rule amending fire safety standards applicable to the following types of Medicare- and Medicaid-participating health care facilities: hospitals, critical access hospitals, long-term...more

CMS Issues Rule to Implement LTCH PPS Wound Care Discharge Payment Policy, Geographic Reclassification Changes

CMS has published an interim final rule with comment period to implement a recent statutory provision addressing Medicare payments to certain rural long-term care hospitals (LTCHs) for severe wound care discharges. By way of...more

CMS's Proposed IPPS and LTCH FY 2017 Rule: Key Takeaways

On April 18, 2016, CMS released its proposed rule addressing new payment rates and policies under both the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS),...more

Federal Court Rejects Hospitals’ Challenge to Medicare Wage Rule 

In a decision with far-reaching implications within the health care industry, on February 22, 2016, a federal judge rejected a challenge to how Medicare reimbursement is adjusted based on local labor costs, dismissing...more

There Is Such a Thing as Being Too Careful

According to The New York Times, Medicare may be punishing hospitals—and academic medical centers (AMCs) in particular—for being too careful. That’s how Northwestern Memorial Hospital’s chief medical officer sees the...more

GAO Recommends Additional Site-Neutral Medicare Payment Policies

On April 13, 2016, the Government Accountability Office (GAO) released another report once again recommending that Congress equalize payment rates for Medicare services across practice settings (e.g., hospital outpatient...more

Ninth Circuit Denies Medicare Payments in Assets-Only Purchase Without Assignment of Provider Agreement

On April 11, 2016, the Ninth Circuit Court of Appeals ruled that a hospital was not entitled to Medicare payments in an assets-only purchase until the Buyer enrolled in the Medicare program because it did not accept the...more

Yet Again, OIG Approves Medigap Policy Contracts with Preferred Hospital Network

On March 11, 2016, the U.S. Department of Health & Human Service, Office of the Inspector General (OIG) issued an advisory opinion approving the use of a preferred hospital network as part of Medicare Supplemental Health...more

Establishing a hospital's per resident amount: Be careful, as the result is permanent!

A teaching hospital's direct graduate medical education (DGME) payments are made on a per resident basis and are based on each hospital’s unique per resident amount (PRA). This PRA, once established, is permanent and cannot...more

Health Law Insights Newsletter - Issue 7 - March 2016

McCarter & English, LLP’s Health Care Group presents Issue 7 of the Health Law Insights, which discusses the latest legal issues in the health care industry. NATIONAL - Providers’ Obligation to Report Medicare...more

Court Allows 'Retroactive' Application of 2005 Wage Index Rule Limiting Reimbursement for Pension Plan Costs

On February 22, 2016, in Regents of the University of California v. Burwell, the U.S. District Court for the District of Columbia granted summary judgment in favor of the Secretary of Health and Human Services (the Secretary)...more

The "predicate facts" rule: Providers, be vigilant!

Medicare GME payments do not compensate teaching hospitals for their actual costs of training residents in a given year. Rather, Medicare GME reimbursement is determined, in part, on the basis of historic cost data and...more

Congress introduces bipartisan legislation to help teaching hospitals with vexing "resident rotator" issue

On March 14, 2016, the US Senate and the US House of Representatives both introduced the Advancing Medical Resident Training in Community Hospitals Act. If passed, this legislation would solve the so-called "resident rotator"...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On March 8, 2016, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule entitled, “Medicare Program; Part B Drug Payment Model.” The proposed rule seeks...more

Comprehensive Joint Replacement Bundled Payment Program Begins April 1st

Approximately 800 hospitals in 67 Metropolitan Statistical Areas will begin mandatory participation in the Comprehensive Care for Joint Replacement (CJR) Model on April 1, 2016. The CJR bundled payment program applies to...more

CMS Extends EHR Incentive Program Hardship Application Deadline to July 1, 2016

CMS is allowing eligible professionals, eligible hospitals, and critical access hospitals to apply for Medicare Electronic Health Record (EHR) Incentive Program hardship exceptions until July 1, 2016 to avoid adjustments to...more

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